Endoscopic necrosectomy through a lumen-apposing metal stent resulting in perforation: is it time to develop dedicated accessories?

Rimbaș, Mihai; Rizzati, Gianenrico; Gasbarrini, Antonio; Costamagna, Guido; Larghi, Alberto

doi:10.1055/s-0043-119974

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Acute pancreatitis (AP) is amongst the most frequent causes of gastrointestinal tract diseases that requires acute hospitalization and its incidence continues to rise [1,2]. Around 20 % of patients with acute pancreatitis develop necrotizing pancreatitis with about a third of them progressing to infected necrosis which is associated with mortality rates reported between 15 % and 30 % [3 -5].…”

Section: Introductionmentioning

confidence: 99%

Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

et al. 2020

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Background and study aims Endoscopic drainage of walled-off necrosis and subsequent endoscopic necrosectomy has been shown to be an effective step-up management strategy in patients with acute necrotizing pancreatitis. One of the limitations of this endoscopic approach however, is the lack of dedicated and effective instruments to remove necrotic tissue. We aimed to evaluate the technical feasibility, safety, and clinical outcome of the EndoRotor, a novel automated mechanical endoscopic tissue resection tool, in patients with necrotizing pancreatitis. Methods Patients with infected necrotizing pancreatitis in need of endoscopic necrosectomy after initial cystogastroscopy, were treated using the EndoRotor. Procedures were performed under conscious or propofol sedation by six experienced endoscopists. Technical feasibility, safety, and clinical outcomes were evaluated and scored. Operator experience was assessed by a short questionnaire. Results Twelve patients with a median age of 60.6 years, underwent a total of 27 procedures for removal of infected pancreatic necrosis using the EndoRotor. Of these, nine patients were treated de novo. Three patients had already undergone unsuccessful endoscopic necrosectomy procedures using conventional tools. The mean size of the walled-off cavities was 117.5 ± 51.9 mm. An average of two procedures (range 1 – 7) per patient was required to achieve complete removal of necrotic tissue with the EndoRotor. No procedure-related adverse events occurred. Endoscopists deemed the device to be easy to use and effective for safe and controlled removal of the necrosis. Conclusions Initial experience with the EndoRotor suggests that this device can safely, rapidly, and effectively remove necrotic tissue in patients with (infected) walled-off pancreatic necrosis.

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Section: Introductionmentioning

confidence: 99%

Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

et al. 2020

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“…The method is well established and has been further developed in recent years, especially with new, specially shaped LAMS that facilitate EUS-guided access to the necrosis cavity[ 5 ]. To our knowledge, new devices designed for necrosectomy have not yet been developed[ 10 - 12 ]. Therefore, DEN is often performed by a combination of sucking debris through the working channel, removing necrotic material with a removal device, and applying irrigation.…”

Section: Discussionmentioning

confidence: 99%

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

Brand¹,

Bachmann²,

Schlag³

et al. 2022

WJGS

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BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and time-consuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking. AIM To evaluate the technical success and safety of the device in a multicenter setting. METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020 and October 2021 for appropriate indications. Overall, 56 procedures were included in the study. We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded. RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies (33 transgastric, 4 transduodenal). In 70% of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent. The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces (range, 2-25 pieces) of necrosis removed in a mean procedure time of 59 min (range, 15-120 min). In addition, the device has been used to remove blood clots ( n = 6), to clear insufficiency cavities before endoluminal vacuum therapy ( n = 5), and to remove foreign bodies from the upper gastrointestinal tract ( n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures. CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.

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“…Direct endoscopic necrosectomy (DEN) of pancreatic necrosis is an important development in interventional endoscopy and has significantly improved the prognosis of these patients [9]. The method is well established and has been further developed in recent years, especially with new, specially shaped LAMS that facilitate EUS-guided access to the necrosis cavity [5].…”

Section: Discussionmentioning

confidence: 99%

The Over the Scope Grasper – A New Tool for Pancreatic Necrosectomy and Beyond – First Multicenter Experience

et al. 2022

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Endoscopic necrosectomy through a lumen-apposing metal stent resulting in perforation: is it time to develop dedicated accessories?

Cited by 5 publications

References 5 publications

Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

The Over the Scope Grasper – A New Tool for Pancreatic Necrosectomy and Beyond – First Multicenter Experience

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