Novel grasp-and-snare technique for efficient endoscopic necrosectomy of walled-off necrosis

Walled-off necrosis (WON) is a significant local complication of severe pancreatitis. Despite the utilization of endoscopic ultrasound-guided drainage, if necrotic debris accumulates within the WON and infection remains uncontrolled, direct endoscopic necrosectomy (DEN) is performed using auxiliary instruments such as forceps or snares [1] [2]. Conventional techniques often involve prolonged and multiple sessions because of their limited ability to remove necrotic material, leading to a substantial patient burden. Here we present an efficient adaptation of the two-channel method [3], commonly utilized for endoscopic mucosal resection ([Fig. 1]), for DEN, termed the "grasp-and-snare" technique. The procedure involves the use of a dual-channel endoscope (GIF-2TQ260M; Olympus, Tokyo, Japan), with one channel used to insert forceps for grasping and pulling lesions toward the operator and the other channel used to insert a snare for resecting the lesions. This technique enables simultaneous traction and snaring, rendering DEN safe and efficient ([Fig. 2], [Video 1]).