Abstract
Direct endoscopic necrosectomy (DEN) for walled-off pancreatic necrosis (WOPN) is an accepted approach with rates of success approaching 80%. A technical protocol for DEN has not been standardized. Limitations include inability to remove sufficient necrotic debris from a collection, need for multiple procedures, prolonged procedure time, and complication rates approaching 25%, with bleeding principle among them. Hydrogen peroxide (H2O2) has been used for debridement of tissue within wounds. Through release of nascent oxygen upon contact with tissue, H2O2's effervescent action dislodges necrotic material, debris, and clots.
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