Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2020; 26(41): 6431-6441
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6431
Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study
Fang Liu, Liang Wu, Xiang-Dong Wang, Jian-Guo Xiao, Wen Li
Fang Liu, Department of Gastroenterology and Hepatology, Medical School of Chinese PLA, Beijing 100853, China
Fang Liu, Xiang-Dong Wang, Wen Li, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Liang Wu, Department of International Center for Diagnosis and Treatment of Liver Disease, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100039, China
Jian-Guo Xiao, Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Liu F and Wu L contributed equally to this manuscript; Li W and Liu F contributed to study conception and design, and the endoscopic operation; Liu F and Wu L wrote and edited the manuscript; Liu F, Wu L, Wang XD, and Xiao JG performed the endoscopic operation, data analysis and interpretation.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the PLA General Hospital, No. s2019-298-02.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Wen Li, MD, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China.
Received: July 30, 2020
Peer-review started: July 23, 2020
First decision: August 8, 2020
Revised: August 22, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 7, 2020
Research background

Endoscopic drainage of walled-off necrosis (WON) is still a challenge due to stent-associated problems.

Research motivation

We explored endoscopic gastric fenestration (EGF) as an innovative alternative intervention for WON.

Research objectives

In this retrospective study, we report our preliminary experience in assessing the feasibility, efficacy and safety of EGF for WON.

Research methods

Five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound (EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent necrosectomy. The detail procedure-related outcome data (including the time of EUS assessment and fenestration procedures), procedure-related complications, postoperative management, procedural cost, overall cost of hospitalization and follow-up, hospital stay, follow-up time and recurrence were recorded.

Research results

EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the subsequent four cases. The average procedural time of EGF was 124 min (EUS assessment, 32.3 min; initial fenestration, 28.8 min; expanded fenestration, 33 min), and tended to decrease as experience of the technique was gained. No EGF-related complications were observed. WON disappeared within 3 wk after EGF. In Case 3, WON, treated by endoscopic lumen-apposing metal stent (LAMS) drainage, recurred within a few days after LAMS removal due to stent-related hemorrhage and showed slow resolution for almost 3 mo. No recurrences were observed in all five patients.

Research conclusions

EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall, and might outperform endoscopic LAMS drainage, involving less cost and no stent-related complications.

Research perspectives

The challenge of this technique resides in the gauging of actual adherence and in selecting appropriate sites for fenestration. We intend to conduct a prospective study to compare EGF with endoscopic LAMS/plastic stent drainage in the future.