Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

Table 1 The baseline characteristics of all five patients in this study

Characteristics	Case 1	Case 2	Case 3	Case 4	Case 5
Age/sex	56/female	63/male	45/male	72/male	64/female
Etiology of NP	High fat diet and cholelithiasis	Cholelithiasis	High fat diet and cholelithiasis	High fat diet	High fat diet and cholelithiasis
Time interval between NP onset and endoscopic procedures (mo)	3	1.3	17	3.5	1.7
Clinical symptoms	Pancreatic pain and gastric outlet obstruction	Pancreatic pain and gastric outlet obstruction	Intra-cystic infection and hemorrhage	Gastric outlet obstruction	Pancreatic pain and gastric outlet obstruction
Diameter of WON (cm)	10.3	13	13.9	9.3	19.5
Multiple cysts of WON	No	No	2 cysts without communication	3 cysts with communication	No

NP: Necrotizing pancreatitis; WON: Walled-off necrosis.

Table 2 The main endoscopic procedural characteristics of all five patients in this study

Characteristics	Case 1	Case 2	Case 3	Case 4	Case 5
Successful EGF	No. Non-adherence of encapsulated WON to the gastric wall. Stent placement also failed, so a nasocystic drainage tube was inserted instead	Yes	Yes	Yes	Yes
Fenestration sites	Posterior wall between gastric antrum and body	Upper posterior wall of gastric body	Greater curvature of gastric fundus	Posterior wall of gastric antrum	Posterior wall between gastric antrum and body
Diameter of fenestration sites (cm)	-	2	1.5	2.5	3
Total procedure time (min)	178	162	117	94	123
EUS assessment time (min)	80	53	20	33	23
Total fenestration time (min)	35	75	60	42	70
Initial fenestration (by ESD approach) time (min)	35	52	19	16	28
Expanded fenestration time (min)	-	23	41	26	42
WON fluid drainage time (min)	-	5	17	13	20
WON exploration and necrosectomy time (min)	-	27	20	6	10
Intraoperative fluid collection of WON (mL)	40 cloudy brown liquid	500 light gray liquid	1000 cloudy brown liquid	400 light gray liquid	1300 yellowish pus
Endoscopic procedural cost ($)	3549.1	2136.4	2381.4	2096.7	1941.5

EGF: Endoscopic gastric fenestration; WON: Walled-off necrosis; EUS: Endoscopic ultrasound; ESD: Endoscopic submucosal dissection.

Table 3 The main postoperative characteristics of all five patients in this study

Characteristics	Case 1	Case 2	Case 3	Case 4	Case 5
Time of postoperative fasting (d)	7	7	7	1	1
Time of nasal-cyst tube indwelling (d)	15	8	7	-	-
Average daily fluid collection via nasal cyst tube (mL)	172	339	97	-	-
Postoperative endoscopic management	The nasocystic tube was reverted to internal drainage 15 d later, and finally removed 3 mo later	One more necrosectomy 1 wk later	A LAMS was placed in another separate WON 16 d after EGF, but removed 1 wk later due to stent-related hemorrhage	One more necrosectomy 1 wk later	One more necrosectomy 1 wk later
Complications	Recurrent infection of WON during initial internal drainage	None	EGF: None.LAMS drainage: Stent-related hemorrhage	None	None
Total endoscopic procedural cost during hospitalization and follow-up ($)	4182.6	2427.2	5852.7	2408.3	2265.9
Overall cost of hospitalization and follow-up ($)	14684.2	7349.1	20198.3	10504.5	12641.4
Postoperative hospital stay (d)	24	12	36	8	9
Time to WON disappearance (d)	92	20	WON underwent EGF: 14WON underwent LAMS drainage: 84	14	21
Time of follow-up (mo)	16	13	12	6	5
Recurrence of WON	No	No	No	No	No

LAMS: Lumen-apposing metal stent; WON: Walled-off necrosis; EGF: Endoscopic gastric fenestration.