Transgastric endoscopic vacuum therapy with a new open-pore film drainage device in a case of infective pancreatic necrosis.

Infected pancreatic necrosis needs to be drained; nowadays this is mostly done by endoscopic means. As yet, few cases of transgastric endoscopic vacuum therapy (EVT) have been reported [1–3]. This is the first case to be reported in which a new open-pore film drainage (OFD) device was used. A 70-year-old man became septic because of infected pancreatic necrosis. Initially the cyst was drained with endoscopic ultrasound (EUS)-guided transgastric drainage and transnasal cavity rinsing. Endoscopic debridement was performed. After a treatment period of 16 days, a cavity of 10cm in diameter that was almost free of necrosis remained (●" Fig.1). Subsequently, drainage treatment was continued with transgastric EVT. We used anewOFDdevice [4–5]. Thedistal endof a drainage tube (Ventrol; 12Fr×120cm; Covidien Argyle, Dublin, Ireland) was wrapped in a very thin open-pore double-layered drainage film (Suprasorb CNP drainage film; Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany) that was secured with a suture thread (●" Fig.2; ●" Video 1). The OFD device was inserted transnasally into the stomach (●" Fig.3). For the placement procedure we used a standard gastroscope. The tip of the drainage tube was grasped with a forceps and pushed forward into the retrogastric cavity under endoscopic view (●" Fig.4a). The small diameter of the OFD device allowed easy transgastric placement without the need for dilation of the gastric opening (●" Fig. 4b;●" Video 1). After application of a vacuum with an electronic vacuum device (KCI V.A.C. Freedome: KCI USA Inc., San Antonio, Texas, USA; setting: −75mmHg, continuous, intensity 10) the cyst shrank immediately around the OFD device. Liquids were Fig.3 The open-pore film drainage (OFD) device is inserted transnasally. Fig.2 The new openpore film drainage (OFD) device: the distal end of a drainage tube is wrapped with an open-pore film. E, endoscope; G, grasper.