title: Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video).
abstract: BACKGROUND
  Walled-off pancreatic necrosis (WOPN) is effectively managed with percutaneous and endoscopic techniques such as direct endoscopic necrosectomy. However, they require repeat interventions and lengthy hospital stays.
  
  
  OBJECTIVE
  To evaluate a new platform to manage WOPNs by using a large-bore, through-the-scope, fully covered, self-expandable metal stent (FCSEMS) to overcome the need for repeat interventions and extended hospital stays.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  Five consecutive patients with symptomatic WOPN underwent EUS-guided drainage of WOPN by using a large-bore FCSEMSs.
  
  
  METHODS
  EUS-guided transgastric drainage of WOPN by using a large-bore FCSEMS. Cross-sectional imaging was repeated at 6- to 8-week intervals. The FCSEMS was removed after WOPN resolution.
  
  
  METHODS
  Clinical success, number of repeat interventions, and length of hospital stay.
  
  
  RESULTS
  Five patients (mean age 60 years) with WOPN (mean diameter, 12.3 cm; range 9.8-14.3 cm) underwent drainage with the described technique. Technical and clinical success was achieved in 100% of patients. Direct endoscopic necrosectomy was not required in any patient. The median number of endoscopic procedures was 1. The median length of hospital stay was 1 day. There were no adverse events.
  
  
  CONCLUSIONS
  Small, retrospective study.
  
  
  CONCLUSIONS
  The described novel platform facilitates resolution of WOPN with a single procedure, avoiding the need for repeat interventions and lengthy hospital stays.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Messallam
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Kamal
authors.affiliation: Department of Radiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D000368:Aged; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional