Cap-Assisted Direct Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: A Case Report

Acute necrotizing pancreatitis is a severe and potentially life-threatening gastrointestinal disease. Walled-off pancreatic necrosis is a serious complication of it. Direct endoscopic necrosectomy (DEN) is considered the first-line therapy. Larger debridement through endoscopy may be both time- and cost-effective, in addition to facilitating faster recovery. Using an endoscopic cap to achieve more necrotic material could be an effective addition to the procedure. A 73-year-old female patient presented with severe abdominal pain, lethargy, and weight loss for the past three months. She was diagnosed with acute necrotizing pancreatitis complicated by an infected walled-off pancreatic necrosis. A total of three, one without and two with cap assistance, DEN procedures were performed. The mean duration of necrosectomy sessions was 52.3 minutes. Large amounts of necrotic material were removed using the endoscopic cap. The patient fully recovered and was discharged without any complications. She is healthy on the six-month follow-up visit. Cap-assisted DEN could be a time- and cost-effective treatment method due to its ability to enable larger debridement.