Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 25, 2016; 8(10): 402-408
Published online May 25, 2016. doi: 10.4253/wjge.v8.i10.402
Safety of direct endoscopic necrosectomy in patients with gastric varices
Andrew C Storm, Christopher C Thompson
Andrew C Storm, Christopher C Thompson, Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA 02115, United States
Author contributions: Storm AC collected data and authored the manuscript; Thompson CC devised study and performed critical review of the manuscript.
Institutional review board statement: Internal approval for data collection pertinent to this study was obtained.
Informed consent statement: Retrospectively collected data made informed consent infeasible.
Conflict-of-interest statement: Dr. Storm reports no conflicts of interest, Dr. Thompson is a consultant to Cook, Olympus and Boston Scientific.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christopher C Thompson, MD, MHES, Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, United States. ccthompson@partners.org
Telephone: +1-617-5258266 Fax: +1-617-5660338
Received: February 9, 2016
Peer-review started: February 9, 2016
First decision: March 9, 2016
Revised: March 16, 2016
Accepted: April 5, 2016
Article in press: April 6, 2016
Published online: May 25, 2016
Core Tip

Core tip: In this retrospective cohort, 15 out of 90 patients (16.7%) presenting for endoscopic necrosectomy had gastric varices. When performed with best practice technique, direct endoscopic necrosectomy may be safely performed in patients with gastric varices. The best practice technique, from Thompson et al. Pancreatology, 2015 includes: (1) EUS evaluation with doppler to confirm absence of intervening vessels; (2) injection of contrast to distend collection and create wall tension for access; (3) stiff guidewire looped in cavity to mark access site for duration of the case; (4) entry into the cavity with stiff balloon catheter dilated to 4-8 mm, then 20 mm; (5) exchange for a large-channel endoscope for lavage and debridement of necrosis; (6) placement of pigtail catheters for ongoing drainage of the cavity; and (7) avoid proton pump inhibitor to encourage ongoing digestion of necrotic material.