Figure 3 Endoscopic step-up approach

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Figure 3 Endoscopic step-up approach Figure 3 | Endoscopic step-up approach. a | The first step of the endoscopic step-up approach is endoscopic transluminal drainage. The preferred access route for endoscopic transluminal treatment is through the posterior wall of the stomach. The necrotic collection often bulges into the stomach, facilitating endoscopic transluminal treatment. The collection is punctured through the gastric wall, followed by balloon dilatation of the tract. Two double-pigtail stents and a nasocystic catheter are placed for continuous postoperative irrigation. b | If necessary, the cystostomy tract is further dilated, the collection is entered by a forward viewing endoscope, and necrosectomy is performed. Reprinted from van Brunschot, S. et al. Treatment of necrotizing pancreatitis. Clin. Gastroenterol. Hepatol. 10, 1190–1201 (2012), with permission from Elsevier ©, and permission obtained from John Wiley and Sons © da Costa, D. W. et al. Br. J. Surg. 101, e65–e79 (2014). Reprinted from van Brunschot, S. et al. Treatment of necrotizing pancreatitis. Clin. Gastroenterol. Hepatol. 10, 1190–1201 (2012), with permission from Elsevier ©, and permission obtained from John Wiley and Sons © da Costa, D. W. et al. Br. J. Surg. 101, e65–e79 (2014) van Grinsven, J. et al.(2016) Timing of catheter drainage in infected necrotizing pancreatitis Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2016.23