Gastroenterologie
a hepatologie

Multiple transluminal gateway technique in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis – a case report

Iva Rennétová¹, Jiřina Pintová ^{Orcid.org  2}

+ Affiliation
¹ Gastroenterologické oddělení, Oblastní nemocnice Mladá Boleslav, a. s., nemocnice Středočeského kraje
² Gastroenterologické oddělení, Nemocnice Jablonec nad Nisou, p.o.

Summary

Acute pancreatitis is an inflammatory disease of the pancreas. In most patients, it occurs in a mild form with spontaneous regression. However, some patients develop severe necrotizing pancreatitis. The aim of this case report is to demonstrate the possibilities of interventional treatment of peripancreatic fluid collections. These collections arise as complications of acute pancreatitis. We present the case of a 41-year- -old man with biliary pancreatitis who developed multiple infected walled-off pancreatic necroses (WON). After conservative treatment failed, endoscopic ultrasound (EUS) -guided drainage of three large collections was done. The procedure used the multiple transluminal gateway technique (MTGT) with lumen-apposing metal stents (LAMS). As the clinical response to drainage was insufficient, endoscopic necrosectomy was subsequently performed. The procedure was carried out using the EndoRotor device, allowing for easier removal of necrotic tissue. The therapy led to gradual regression of the collections, clinical stabilization, and complete recovery of the patient. This treatment follows the “step-up approach”, starting with less invasive methods and progressing to more invasive ones. The MTGT technique has proven to be effective especially in cases with multiple or extensive collections, where a single-access approach would be insufficient, as demonstrated in this case report.

Keywords

endoscopic drainage, lumen-apposing metal stents, walled-off pancreatic necrosis, pancreatic fluid collection

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