Todd H. Baron, Richard A. Kozarek

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Presentation transcript:

Endotherapy for Organized Pancreatic Necrosis: Perspectives After 20 Years Todd H. Baron, Richard A. Kozarek Clinical Gastroenterology and Hepatology Volume 10, Issue 11, Pages 1202-1207 (November 2012) DOI: 10.1016/j.cgh.2012.07.009 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Illustration of transgastric drainage of necrosis with nasocystic irrigation. Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 (A) Coronal CT image obtained after transgastric necrosectomy of sterile necrosis; transgastric stent is present within superior portion of cavity (arrow). Left paracolic extension is seen (arrows). The 2 components of the collection communicate. (B) Percutaneous drainage is required to treat the contaminated paracolic gutter collection (arrows from midline to patient's left represent feeding tube, transgastric stent, and gutter collection with contrast, respectively). Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 Direct endoscopic necrosectomy. (A) Illustration showing direct endoscopic necrosectomy. (B) Endoscopic photo taken from within the necrotic cavity. (C) Gross picture of large volume of necrosis removed during direct endoscopic necrosectomy. Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 (A) Illustration showing right pelvic necrotic collection with self-expandable metal stents in place to perform direct necrosectomy. (B) Radiographic image of endoscope passed through self-expandable metal stents to perform direct necrosectomy of pelvic gutter collection. Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 5 Illustration of hybrid percutaneous endoscopic technique. The percutaneous tube is used to provide irrigation that passes through the internal stents. Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 6 Illustration showing the multigateway approach. Nasocystic irrigation tube (inside endoscope) is passed through 1 of the 2 transluminal entry sites alongside double pigtail stents. Clinical Gastroenterology and Hepatology 2012 10, 1202-1207DOI: (10.1016/j.cgh.2012.07.009) Copyright © 2012 AGA Institute Terms and Conditions