Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2016; 22(21): 5132-5136
Published online Jun 7, 2016. doi: 10.3748/wjg.v22.i21.5132
Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report
Kosuke Minaga, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Tomohiko Matsuda, Shunsuke Omoto, Kumpei Kadosaka, Tomoe Yoshikawa, Masatoshi Kudo
Kosuke Minaga, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Tomohiko Matsuda, Shunsuke Omoto, Kumpei Kadosaka, Tomoe Yoshikawa, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-Sayama 589-8511, Japan
Author contributions: Minaga K contributed to manuscript writing, performing endoscopic interventions; Kitano M contributed to drafting conception and design, performing endoscopic interventions; Imai H, Yamao K, Kamata K, Miyata T, Matsuda T, Omoto S, Kadosaka K and Yoshikawa T contributed to writing the manuscript; Kudo M contributed to drafting conception and design; all authors helped to perform the research.
Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy, No. 22590764 and No. 25461035.
Institutional review board statement: This study was approved by the Institutional Review Board of Kinki University Faculty of Medicine.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
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: Masayuki Kitano, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan. m-kitano@med.kindai.ac.jp
Telephone: +81-72-3660221 Fax: +81-72-3672880
Received: January 9, 2016
Peer-review started: January 10, 2016
First decision: February 18, 2016
Revised: February 24, 2016
Accepted: March 18, 2016
Article in press: March 18, 2016
Published online: June 7, 2016
Processing time: 141 Days and 18.2 Hours
Abstract

We report a successful endoscopic ultrasonography-guided drainage of a huge infected multilocular walled-off necrosis (WON) that was treated by a modified single transluminal gateway transcystic multiple drainage (SGTMD) technique. After placing a wide-caliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.

Keywords: Endoscopic ultrasonography; Infected pancreatic necrosis; Walled-off necrosis; Endoscopic ultrasonography-guided drainage; Acute pancreatitis

Core tip: Walled-off necrosis (WON) remains difficult to endoscopically manage because of insufficient drainage of solid necrotic tissues. Here, we present a case of successful drainage of a huge WON via a modified single transluminal gateway transcystic multiple drainage technique. After placing a wide-caliber covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula created by the metal stent enabled the insertion of an upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity.