✦ PANCREAS · ENDOSCOPIC

Endoscopic Necrosectomy

Q: How many sessions of endoscopic necrosectomy are needed?

Most patients require 3–5 sessions every 2–4 days. The number depends on necrosis volume and clinical improvement.

Q: What is the success rate of endoscopic necrosectomy?

Endoscopic necrosectomy achieves clinical success in 75–85% of appropriately selected patients.

Q: Can endoscopic necrosectomy be done on any patient with pancreatic necrosis?

No — endoscopic access requires the necrosis to be adjacent to the stomach or duodenum wall to allow transmural stent placement.

Minimally invasive endoscopic debridement of infected pancreatic necrosis — no external incisions.

60–120 Min TREATMENT DURATION

3–5 Days CARE SETTING

Endoscopic APPROACH

2–3 Weeks RECOVERY TIMELINE

What is Endoscopic Necrosectomy?

Endoscopic necrosectomy debrides infected pancreatic necrosis (walled-off necrosis) through an endoscopic transluminal approach. A transmural stent created under EUS guidance allows a flexible endoscope to be passed directly into the necrotic cavity for direct debridement and irrigation. Dr. Tagore Mohan Grandhi performs endoscopic necrosectomy as part of the step-up approach for infected walled-off necrosis. Multiple sessions are typically required for complete debridement. No external incisions are needed.

Suitable for patients with infected walled-off necrosis accessible via the stomach or duodenum wall, as the preferred minimally invasive debridement approach after initial percutaneous drainage has been established.

How the Procedure Works

EUS-Guided Access

Endoscopic ultrasound identifies the optimal access point through the stomach or duodenum. Lumen-apposing metal stent (LAMS) placed creating access between the bowel and necrotic cavity.

Endoscope Entry

Flexible endoscope passed through the transmural stent into the necrotic cavity. Cavity irrigated with saline to improve visualisation.

Necrotic Debridement

Necrotic material removed under direct endoscopic vision using forceps, suction, and irrigation. Multiple sessions needed for complete debridement.

Between Sessions

Transmural stent maintains drainage between sessions. Patient monitored radiologically to assess resolution.

Stent Removal

Once the cavity is clean and contracted, stent is removed endoscopically. Cavity closes spontaneously. CT confirms resolution.

Outcomes

60–120 MinTREATMENT DURATION

3–5 DaysCARE SETTING

EndoscopicAPPROACH

2–3 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→No external incisions — all debridement performed endoscopically through the mouth
→Significantly lower morbidity and mortality than open surgical necrosectomy
→Preferred for infected walled-off necrosis accessible via stomach or duodenum
→Possible in critically ill patients unsuitable for open surgery

Endoscopic necrosectomy has changed how we treat this devastating complication. Performing surgical-quality debridement through the mouth without a single incision and achieving results previously only possible with open surgery is remarkable.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

How many sessions of endoscopic necrosectomy are needed?+

What is the success rate of endoscopic necrosectomy?+

Can endoscopic necrosectomy be done on any patient with pancreatic necrosis?+

Not sure which treatment is right for you?

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