Percutaneous direct endoscopic pancreatic necrosectomy

Table 3 Advantages and disadvantages of percutaneous direct endoscopic necrosectomy

No.	Advantages	Disadvantages
1	It can be done in critically ill patients where laparoscopy access is not possible- bed side	More invasive (compared to transmural necrosectomy) (Multiple interventions-percutaneous drainage followed by multiple tract dilation/drainage catheter exchanges, if not stent-assisted percutaneous direct endoscopic necrosectomy)
2	Subsequent liquefied necrosis drained by gravity	Small endoscopic accessories for necrosectomy-hence, time-consuming and labour-intensive procedure (compared to VARD/surgical necrosectomy)
3	No intraperitoneal transmission (retroperitoneal approach); a fully covered self-expandable metal stent may help to prevent intraperitoneal transmission in transperitoneal approach	The need for repeated procedures for effective drainage (compared to VARD/surgical necrosectomy)
4	Access various extensions deep within the abdomen using the flexible endoscope’s angulation and versatility (Figures 3C and 6C)	Pancreatico-cutaneous fistula (compared to transmural necrosectomy)
5	Usually carried out under deep sedation; general anaesthesia avoided	-

VARD: Video-assisted retroperitoneal drainage.