Endoscopic transgastric fenestration versus percutaneous drainage for management of (peri)pancreatic fluid collections adjacent to gastric wall (with video)

Figure 1 Endoscopic transgastric fenestration: From location to endoscopic full-thickness resection. A: Preoperative computed tomography scan of (peri) pancreatic collections; B: Gastric bulge caused by (peri) pancreatic collections under upper endoscope view; C: Assessment of fenestration site under endoscopic ultrasound; D: Marked the mucous layer; E: Resect the mucosal layer by endoscopic mucosal resection; F: Full-thickness incision was operated.

Figure 2 Endoscopic transgastric fenestration: Enlarge the aperture of opening and debridement. A: Collections inflowing via the artificial fistula; B: Enlarged the aperture of opening with hook knife; C: The artificial fistula (about 2 cm in diameter) between the gastric wall and the cavity was made; D: Debridement of necrotic tissue under endoscopic direct vision; E: Endoscopic review of the fistula showed fistula almost healed one months later; F: The reviewed computed tomography scan one month after endoscopic transgastric fenestration.

Figure 3 Flow-chart for this retrospective study. ETGF: Endoscopic transgastric fenestration; PFCs: (peri) Pancreatic collections; PCD: Percutaneous drainage.