title: Large area of walled-off pancreatic necrosis successfully treated by endoscopic necrosectomy using a grasping-type scissors forceps.
abstract: Endoscopic necrosectomy (EN) for walled-off pancreatic necrosis (WOPN) is less invasive than surgical treatment and has become the first choice for pancreatic abscess. EN is usually carried out with several devices including snares, baskets, and grasping forceps. Occasionally, we have encountered cases in which EN has not been satisfactorily carried out, and there is pressure for further innovation in EN. Here, we describe a case of a large area of WOPN that was successfully treated by EN with endoscopic submucosal dissection and associated techniques, which facilitated removal of necrotic tissues. A 60-year-old man was referred to our hospital for WOPN as a complication of necrotizing pancreatitis. As a result of his complicating conditions including ischemic heart disease, uncontrollable arrhythmia, chronic renal failure, and persistent pleural effusion, he was deemed a poor surgical candidate. Although EN with conventional devices was carried out for five sessions, we could not remove the dense and massive necrotic tissues. At the sixth EN session, the Clutch Cutter device (Fujifilm, Tokyo, Japan) was used to remove the necrotic tissues, without major complications. This is believed to be the first report of EN using the Clutch Cutter for successful treatment of WOPN.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka.
authors.forename: Akira
authors.initials: A
authors.lastname: Aso
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Matsui
authors.forename: Eikichi
authors.initials: E
authors.lastname: Ihara
authors.forename: Takehiro
authors.initials: T
authors.lastname: Takaoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Osoegawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Niina
authors.forename: Takamasa
authors.initials: T
authors.lastname: Oono
authors.forename: Kazuya
authors.initials: K
authors.lastname: Akahoshi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakamura
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
mesh_terms: D003646:Debridement / Q000295:instrumentation* / Q000379:methods; D018450:Disease Progression; D004724:Endoscopy / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D009336:Necrosis / Q000473:pathology / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: endoscopic necrosectomy; endoscopic submucosal dissection; walled-off pancreatic necrosis