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Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

World Journal of Gastroenterology 2020年第41期26卷 6431-6441页

作者： Fang Liu Liang Wu Xiang-Dong Wang Jian-Guo Xiao Wen Li Department of Gastroenterology and Hepatology Medical School of Chinese PLABeijing 100853China Department of Gastroenterology and Hepatology The First Medical CenterChinese PLA General HospitalBeijing 100853China Department of International Center for Diagnosis and Treatment of Liver Disease The Fifth Medical CenterChinese PLA General HospitalBeijing 100039China Department of Critical Care Medicine The First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND Endoscopic drainage of walled-off necrosis(WON) is still a challenge due to stentassociated problems. We explored endoscopic gastric fenestration(EGF) as an innovative alternative *** To assess the feasibility, efficacy and safety of EGF for *** Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound(EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent *** EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min(EUS assessment, 32.3 min;initial fenestration, 28.8 min;expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent(LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five *** EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.

关键词： Endoscopic gastric fenestration Walled-off necrosis Lumen-apposing metal stents stent-related complications

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