title: A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance.
abstract: We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Minaga
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan. mamoxyo45@gmail.com.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takenaka
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Omoto
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kamata
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamao
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Imai
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: Acute necrotizing pancreatitis; Bile ducts; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasonography; Sonazoid