title: Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).
abstract: BACKGROUND
  Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%.
  
  
  OBJECTIVE
  Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy.
  
  
  RESULTS
  Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients.
  
  
  CONCLUSIONS
  Small number of patients.
  
  
  CONCLUSIONS
  The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.
authors.affiliation: Department of Medicine II, University of Leipzig, Leipzig, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Raczynski
authors.forename: Niels
authors.initials: N
authors.lastname: Teich
authors.forename: Gudrun
authors.initials: G
authors.lastname: Borte
authors.forename: Henning
authors.initials: H
authors.lastname: Wittenburg
authors.forename: Joachim
authors.initials: J
authors.lastname: Mössner
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
mesh_terms: D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000628:therapy*; D016896:Treatment Outcome; D014741:Video Recording