Intragastric Endoscopically Guided Pancreatic Cyst-Gastrostomy & Necrosectomy

Ryan D Horsley, DO, Thomas Shin, MD, Piotr Krecioch, MD, Anthony T Petrick, MD, Harshit S Khara, MD, Jon D Gabrielsen, MD. Geisinger Medical Center

We present a case of a 57 year old patient with a history of ulcerative colitis and alcohol abuse presenting initially with gallstone pancreatitis who developed walled off pancreatic necrosis (WON) three weeks s/p laparoscopic converted to open cholecystectomy. His WON was initially treated with placement of two fully covered, double flanged, lumen opposing, metal stents for internal drainage. A total of 6 sessions of endoscopic debridement were performed, each providing temporary relief; however, the patient repeatedly returned with fever, bacteremia, po intolerance, and malnutrition requiring TPN. Therefore, a more definitive treatment option was required in order to accomplish the goals of wide internal drainage and more effective necrosectomy.

A multidisciplinary approach utilizing both advanced endoscopists and surgeons was used to perform an intra-gastric endoscopically guided stapled pancreatic cyst-gastrostomy. This was performed via one laparoscopic port placed directly into the stomach then using a standard laparoscopic stapler, grasper, and suction irrigator. Utilization of this technique resulted in complete resolution of the WON and no further endoscopic or surgical interventions were required.

In conclusion, we present this novel technique of endoscopically guided stapled pancreatic cyst-gastrostomy for wide internal drainage and extensive debridement of walled off pancreatic necrosis as an effective, minimally invasive treatment when purely endoscopic techniques fail.

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