Storm AC, Thompson CC. Safety of direct endoscopic necrosectomy in patients with gastric varices. World J Gastrointest Endosc 2016; 8(10): 402-408 [PMID: 27247707 DOI: 10.4253/wjge.v8.i10.402]
Corresponding Author of This Article
Christopher C Thompson, MD, MHES, Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, United States. ccthompson@partners.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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Storm AC, Thompson CC. Safety of direct endoscopic necrosectomy in patients with gastric varices. World J Gastrointest Endosc 2016; 8(10): 402-408 [PMID: 27247707 DOI: 10.4253/wjge.v8.i10.402]
World J Gastrointest Endosc. May 25, 2016; 8(10): 402-408 Published online May 25, 2016. doi: 10.4253/wjge.v8.i10.402
Safety of direct endoscopic necrosectomy in patients with gastric varices
Andrew C Storm, Christopher C Thompson
Andrew C Storm, Christopher C Thompson, Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA 02115, United States
Author contributions: Storm AC collected data and authored the manuscript; Thompson CC devised study and performed critical review of the manuscript.
Institutional review board statement: Internal approval for data collection pertinent to this study was obtained.
Informed consent statement: Retrospectively collected data made informed consent infeasible.
Conflict-of-interest statement: Dr. Storm reports no conflicts of interest, Dr. Thompson is a consultant to Cook, Olympus and Boston Scientific.
Data sharing statement: No additional data are available.
Correspondence to: Christopher C Thompson, MD, MHES, Department of Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, United States. ccthompson@partners.org
Telephone: +1-617-5258266 Fax: +1-617-5660338
Received: February 9, 2016 Peer-review started: February 9, 2016 First decision: March 9, 2016 Revised: March 16, 2016 Accepted: April 5, 2016 Article in press: April 6, 2016 Published online: May 25, 2016 Processing time: 98 Days and 9.4 Hours
Core Tip
Core tip: In this retrospective cohort, 15 out of 90 patients (16.7%) presenting for endoscopic necrosectomy had gastric varices. When performed with best practice technique, direct endoscopic necrosectomy may be safely performed in patients with gastric varices. The best practice technique, from Thompson et al. Pancreatology, 2015 includes: (1) EUS evaluation with doppler to confirm absence of intervening vessels; (2) injection of contrast to distend collection and create wall tension for access; (3) stiff guidewire looped in cavity to mark access site for duration of the case; (4) entry into the cavity with stiff balloon catheter dilated to 4-8 mm, then 20 mm; (5) exchange for a large-channel endoscope for lavage and debridement of necrosis; (6) placement of pigtail catheters for ongoing drainage of the cavity; and (7) avoid proton pump inhibitor to encourage ongoing digestion of necrotic material.
