LAUSR

A 41-year-old man with acute pancreatitis of unknown etiology developed a 17×8-cm walled-off necrosis (WON) that was drained percutaneously. The purulent fluid grew Klebsiella and Candida albicans. After transfer to our hospital, endoscopic ultrasound (EUS)-guided drainage was performed, and a 20×10-mm Axios stent was placed. The solid component of the WON was about 90% and direct endoscopic necrosectomy (DEN) was scheduled. DEN was started with a 3.2-mm EndoRotor catheter that broke after a few minutes of use. The following day, the new 6-mm EndoRotor catheter was utilized in association with an Olympus GIF-XTQ160 scope. The catheter was placed through the Axios stent (▶Fig. 1), and in a 70-minute procedure, it was able to aspirate all necrotic content, amounting to 800mL of collected material (▶Video 1). A 77-year-old woman developed biliary acute pancreatitis, complicated by the formation of a large infected WON (16×10mm, necrotic content 80%), which was drained emergently using a 20×10-mm Axios stent. DEN was performed 3 days later using the 6-mm EndoRotor catheter, and in a 90-minute procedure, 90% clearance of the necrotic content amounting to 600mL of collected material had been achieved. We report, for the first time, utilization of the new 6mm EndoRotor catheter, which represents an evolved version of the 3.2-mm tool, the first dedicated device for DEN [1–3]. This new catheter can be used with the Olympus GIF-XTQ160 scope (▶Fig. 2 a) or with an accessory catheter channel that can be attached to an Olympus GIF290 or equivalent Fuji/ Pentax scopes (▶Fig. 2 b). Compared to the 3.2-mm catheter, the 6.0-mm catheter has a 4.4-times larger cutting window and a 2.5-times larger inner lumen, which allows for an 8-times greater throughput and possibly faster and more effective DEN. The average number of procedures required to treat WON with the 3.2-mm catheter has been reported to be 2.1; this number might be decreased by use of the 6-mm device [4].