Percutaneous direct endoscopic pancreatic necrosectomy

Figure 1 Schematic representation of steps involved in percutaneous direct endoscopic necrosectomy. A: Image-guided pigtail drainage of infected pancreatic/peripancreatic collection; B: Partial resolution of infected walled off pancreatic necrosis (WOPN) with maturation of drainage tract between the skin and WOPN (usually 7-10 d approximately); C and D: Drainage tract dilation with (C) wire-guided controlled radial expansion balloon or (D) an esophageal fully covered self-expandable metal stent (SEMS); E and F: Percutaneous direct endoscopic necrosectomy with flexible endoscope through (E) the dilated tract or (F) a fully covered SEMS; G: Placement of large bore abdominal drain and irrigation catheter for drainage and irrigation of WOPN cavity, respectively.