Percutaneous minimally invasive necrosectomy following endoscopic transgastric drainage in acute necrotising pancreatitis.

A patient who had undergone failed transgastric placement of two cystgastrostomy stents referred to the regional pancreatic unit with ongoing sepsis for further management. Following stabilisation, percutaneous minimally invasive necrosectomy (MIN) was performed. MIN resulted in sustained clinical resolution of the sepsis and normalisation of serum C reactive protein levels. The transgastric drains were removed by MIN and, importantly, the patient did not develop a gastric fistula. To our knowledge, this is the first report of MIN following endoscopic cystgastrostomy stent placement. Pancreatic necrosis progresses from solid to semisolid to liquid states over a period of several months. Transgastric drainage should be reserved for subjects with either a pancreatic abscess or predominantly liquid necrosis reserving MIN for patients with systemic sepsis and those with semisolid necrosis. As increasing strategies to treat pancreatic necrosis become available clinicians must be alert to the development of new complications of these treatments.