Further Validation for a Motorized Endoscopic Necrosectomy Device
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Further Validation for a Motorized Endoscopic Necrosectomy Device

Bret T. Petersen, MD, MASGE, reviewing Stassen PMC, et al. Gastrointest Endosc 2021 Sep 22.

Many patients with walled-off pancreatic necrosis (WON) require debridement following minimally invasive drainage. This often entails serial procedures with cumulative expense and risk. These authors present the results of a prospective multicenter trial of necrosectomy performed with the use of a novel motorized debridement system. The trial included 30 adult patients with WON collections measuring 6 to 22 cm (median, 11.1 cm maximal dimension) and containing >30% (median, 75%) solid material. General anesthesia or monitored anesthesia care was used in 77% and 23% of procedures, respectively. 

Complete debridement was accomplished during one session in 15 patients (50%) and within 2 sessions in 20 patients (range, 1-7 procedures; median, 1.5 procedures). The number of interventions correlated with the initial volume of WON. One patient completely failed necrosectomy with the study device and was converted to standard therapy after two procedures. Nine serious adverse events and 11 nonserious events occurred in 10 patients, including 5 events possibly related to the necrosectomy procedures but none overtly related to the device.

Bret T. Petersen, MD, FASGE

COMMENT

Severe necrotizing pancreatitis is a highly morbid disease. Current practice most often employs inefficient snare removal of necrotic debris, avoiding grasping or cutting instruments, given the proximity of friable tissues and major vasculature. Improved techniques and instruments are greatly needed. This study describes the first significant experience with one new device for flushing, suctioning, and excising necrotic tissue. Typical morbidity was noted but was not overtly attributable to the device. Further randomized studies will be helpful to clarify both the efficacy and safety of this device.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Stassen PMC, de Jonge PJF, Bruno MJ, et al. Safety and efficacy of a novel resection system for direct endoscopic necrosectomy of walled-off pancreas necrosis: a prospective, international, multicenter trial. Gastrointest Endosc 2021 Sep 22. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.09.025)

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