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Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device

Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this pur...

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Autores principales: Binda, Cecilia, Coluccio, Chiara, Vizzuso, Antonio, Sartini, Alessandro, Sbrancia, Monica, Cucchetti, Alessandro, Giampalma, Emanuela, Fabbri, Stefano, Ercolani, Giorgio, Fabbri, Carlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378507/
https://www.ncbi.nlm.nih.gov/pubmed/37510064
http://dx.doi.org/10.3390/diagnostics13142321
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author Binda, Cecilia
Coluccio, Chiara
Vizzuso, Antonio
Sartini, Alessandro
Sbrancia, Monica
Cucchetti, Alessandro
Giampalma, Emanuela
Fabbri, Stefano
Ercolani, Giorgio
Fabbri, Carlo
author_facet Binda, Cecilia
Coluccio, Chiara
Vizzuso, Antonio
Sartini, Alessandro
Sbrancia, Monica
Cucchetti, Alessandro
Giampalma, Emanuela
Fabbri, Stefano
Ercolani, Giorgio
Fabbri, Carlo
author_sort Binda, Cecilia
collection PubMed
description Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting.
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spelling pubmed-103785072023-07-29 Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device Binda, Cecilia Coluccio, Chiara Vizzuso, Antonio Sartini, Alessandro Sbrancia, Monica Cucchetti, Alessandro Giampalma, Emanuela Fabbri, Stefano Ercolani, Giorgio Fabbri, Carlo Diagnostics (Basel) Case Report Direct endoscopic necrosectomy (DEN) is a challenging procedure for the debridement of walled-off pancreatic necrosis (WOPN), which may be complicated by several adverse events, primarily bleeding which may require radiological embolization or even surgery. The lack of dedicated devices for this purpose largely affects the possibility of safely performing DEN which increases the risk of complications. We present the case of a 63 years-old man who underwent an endoscopic ultrasound (EUS)-guided drainage of a WOPN, and who was readmitted one month after stent removal with clinical, endoscopic, and radiological signs of infected necrosis involving the splenic artery. A second EUS-guided drainage was performed, with clear visualization of the arterial vessel in the midst of a large amount of solid necrosis. Due to the high risk of major bleeding during DEN, a hybrid procedure in the angiographic room was performed, in order to identify and avoid, under fluoroscopic control, the splenic artery during the entire procedure guide, which was successfully performed using the EndoRotor system. We hereby review the current literature regarding DEN using the EndoRotor system. The case reported, with a literature overview, may help the management of these patients affected by benign but life-threatening conditions which involve a multidisciplinary setting. MDPI 2023-07-10 /pmc/articles/PMC10378507/ /pubmed/37510064 http://dx.doi.org/10.3390/diagnostics13142321 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Binda, Cecilia
Coluccio, Chiara
Vizzuso, Antonio
Sartini, Alessandro
Sbrancia, Monica
Cucchetti, Alessandro
Giampalma, Emanuela
Fabbri, Stefano
Ercolani, Giorgio
Fabbri, Carlo
Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title_full Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title_fullStr Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title_full_unstemmed Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title_short Direct Endoscopic Necrosectomy of a Recurrent Walled-Off Pancreatic Necrosis at High Risk for Severe Bleeding: A Hybrid Technique Using a Dedicated Device
title_sort direct endoscopic necrosectomy of a recurrent walled-off pancreatic necrosis at high risk for severe bleeding: a hybrid technique using a dedicated device
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378507/
https://www.ncbi.nlm.nih.gov/pubmed/37510064
http://dx.doi.org/10.3390/diagnostics13142321
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