Published online May 25, 2016. doi: 10.4253/wjge.v8.i10.402
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: 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.