Endoscopic Ultrasound-Guided Transluminal Drainage and Direct Endoscopic Necrosectomy in Patients with Walled-Off Necrosis

Abstract

Management of Walled-Off Necrosis (WON) poses a high mortality risk with a non-interventional approach. Minimally invasive techniques, including endoscopic ultrasound-guided cystogastrostomy with a step-up approach, have gained prominence. This study retrospectively analyzed data from 18 patients (2016–2018) who underwent endoscopic ultrasound-guided cystogastrostomy, with 13 subsequently undergoing direct endoscopic necrosectomy (DEN) using lumen apposing metal stents (LAMS). The insertion of cystogastrostomy stents was technically successful in all patients. Two patients experienced perforation following LAMS placement. Cyst size positively correlated with hospital stay duration. Between LAMS with pigtail (n=7) and without pigtail (n=6) groups, session numbers, stent duration, and hospital stay did not significantly differ, though numerical reductions were observed in pigtail cases. A moderate correlation existed between stent duration and amylase levels (r=-0.575, p=0.040). Percutaneous drainage catheters (PDC) were necessary in two patients without endoscopic access, and PDC patients had prolonged hospital stays. LAMS-supported EUS-DEN was a low-complication, high-success approach for symptomatic or infected WON. Perforation was identified as a severe complication. The addition of pigtail catheters within SEMS may positively impact session numbers, hospitalization duration, and stent residence time. Prospective cohorts are warranted for further validation. © 2025, Ondokuz Mayis Universitesi. All rights reserved.