TREATMENT OF NECROTIZING PANCREATITIS
Figure 6. ETD and ETN. A large peripancreatic collection containing fluid and necrosis is shown. The preferred access route for endoscopic translumi- nal treatment is through the posterior wall of the stomach. The necrotic collection often bulges into the stomach, facilitating endoscopic transluminal treat- ment. (A) The collection is punc- tured through the gastric wall, followed by balloon dilatation of the tract. Two double-pigtail stents and a nasocystic catheter are placed for continuous postoperative irrigation. (B) The cystostomy tract is further dilated, the collection is entered by a forward viewing endoscope, and necrosectomy is performed.
At the end of the procedure, two double-pigtail stents and a nasocystic catheter are placed. If necessary, ETN can be repeated until the majority of necrotic material is removed.98,99,103-112 By avoiding any abdominal wall incision, typical complications related to surgical necrosectomy such as incisional hernias, pancreatic fistula and wound infection will probably be reduced with ETN. In a recent systematic review of 10 series on ETN in necrotizing pancreatitis overall mortality after ETN was 5% and the mean procedure related morbidity 27%. In 76% of 241