Safety of direct endoscopic necrosectomy in patients with gastric varices

Figure 1 Endoscopic ultrasound of walled off necrosis. A: Doppler used to visualize any interventing vessels (arrow) including varices; B: FNA needle (arrow) seen entering necrotic cyst under EUS guidance. EUS: External urethral sphincter; FNA: Fine-needle aspiration.

Figure 2 Endoscopic necrosectomy performed with debridement of the cyst cavity. Wire is seen coiled within the cyst to maintain access through the procedure.

Figure 3 Pigtail stents left in place at the end of endoscopic necrosectomy to encourage ongoing drainage.

Figure 4 Varices identified through various methods. A: Large gastric varix (arrow) seen endoscopically; B: Peri-gastric varix (arrow) seen within the cyst cavity during endoscopic necrosectomy; C: Computed tomography scan showing gastric varices (arrows) in close proximity to the stomach (S) and walled off necrosis (WON).

Figure 5 Status-post balloon dilation of the necrosectomy tract, shown with self-limited bleeding.