Background:
EUS-guided drainage is suggested as the first approach in the management of symptomatic,
complicated WON. A step-up approach is proposed in case of either refractory or complex
collections. Recently, a new LAMS with an integrated electrocautery delivery system
have been developed, facilitating drainage, reducing procedural timing and hospital
stay. Although a single transluminal access is preferred, multiple step-up gateway
technique is proposed in case of multiple, large or low-responding WON.
Methods:
We present our preliminary experience on patients with symptomatic complex WON, defined
as large (> 12 mm), septated or multiple, drained with a single-step, multiple gateway
technique using EC-LAMS. All procedures were performed after 4 weeks from the onset
and conservative treatment failure. Patients demographic, technical and clinical success,
procedure time, necrosectomy sessions, further treatment needed, adverse events and
post-procedure hospitalization were recorded and statistically analyzed.
Results:
This is a retrospective analysis of prospective collected data of five consecutive
patients with symptomatic complex WON. WON were single with septa in 3 patients, multiple
in 2 patients. 10 EC-LAMS were deployed with both transgastric and transduodenal approach.
Technical success was 100%. The mean time for procedure was 29 min. Necrosectomy was
completed in up to 3 sessions, achieving clinical success in 3 cases (80%), with no
recurrence in all the patients. One patient required a concomitant percutaneous drainage.
We reported one moderate bleeding, in the first post-operative day (POD) treated endoscopically
and one severe bleeding, on 10th POD, requiring embolization and surgery with concomitant necrosectomy.
Conclusion:
Patients affected by multiple, septated, large WON can be considered “hard-to-treat-patients”
and a single gateway could represent an insufficient treatment. Our case series showed
that a single-step multiple gateway technique using EC-LAMS is safe and feasible.
However further prospective, randomized, controlled studies are needed to define the
long-term outcomes of this approach.
