Use of an endoscopic powered debridement device for treatment of post-surgical fatty pancreatic necrosis

Acute pancreatitis can progress to necrosis of the pancreatic tissue and/or peripancreatic tissue which will require intervention if the necrosis becomes infected. 1Alternatively, a feared adverse event of performing a distal pancreatectomy is the development of a pancreatic leak, which can lead to pancreatic fluid collections. 2While traditional management entailed utilization of percutaneous drains or re-operation, endoscopic transmural drainage offers another treatment option for these collections. 3e describe a case of utilizing endoscopic powered debridement devices to treat a large post-operative collection with primarily fatty contents.Consent was obtained from the patient for submission of this case report.A 71-year-old man with a history of pancreatic neuroendocrine tumor status post distal pancreatectomy developed a large walled-off pancreatic necrosis (WOPN) collection.He initially underwent dual-modality drainage via endoscopic ultrasound-guided cystogastrostomy with a lumen-apposing metal stent (LAMS) and percutaneous drain placement.Due to the increasing size of the collection, we performed direct endoscopic necrosectomy (DEN).The entrance through the LAMS revealed a large cavity filled