Hydrogen Peroxide-Assisted Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: A Dual Center Pilot Experience

Abstract

Pancreatic necrosis (PNec) is a serious local complication occurring in 10–15 % of patients with acute pancreatitis (AP). Necrotizing pancreatitis can organize into necrotic collections, termed walled-off necrosis (WON) [1, 2]. Symptomatic WON has traditionally been treated operatively [3]. In several recent trials, successful resolution of WON was achieved using endoscopic therapy, termed direct endoscopic necrosectomy (DEN) [4, 5]. A challenge to DEN is removal of all necrotic material from within the collection [6, 7]. Hydrogen peroxide (H2O2) is acknowledged as an effective means to achieve mechanical debridement of wounds [8–11]. In this case series, we describe a dual center experience with the use of H2O2 to facilitate removal of necrotic debris in patients undergoing DEN as the preliminary measure for management of WON.