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Transmural Drainage with Lumen Apposing Fully Covered Self-expanding Metal Stent and Hydrogen Peroxide Lavage Improves Clinical Outcomes in Patients with Walled-off Pancreatic Necrosis

Adam Wesley Coe, Joshua Blake French, John Alfred Evans, Rishi Pawa

Context Acute necrotizing pancreatitis, with an incidence of nearly 20% in patients with acute pancreatitis, can lead to significant morbidity and mortality. Management can be difficult and at times requires a multidisciplinary approach. Endoscopic and minimally invasive techniques can reduce end-organ failure, procedure related complications, and the high mortality associated with acute necrotizing pancreatitis. Case series We present a series of six consecutive patients who underwent successful Endoscopic Ultrasound guided necrosectomy of symptomatic walled-off pancreatic necrosis using a lumen-apposing fully covered self-expanding metal stent and hydrogen peroxide. Technical success was achieved in 100% of patients. Clinical success was achieved in 83% of patients. Cross-sectional imaging confirmed resolution of walled-off pancreatic necrosis in these patients during follow up. The mean number of endoscopic sessions to perform direct endoscopic necrosectomy was 3.0 and the average follow up duration was 5.5 months. In our series of patients with walled-off pancreatic necrosis, Endoscopic Ultrasound-guided necrosectomy with lumen-apposing fully covered self-expanding metal stents and hydrogen peroxide was both feasible and efficacious. There were no procedure-related adverse events and all patients had resolution of their necroma after treatment except for one that died from other non-procedure related causes.