Retroperitoneal endoscopic debridement for infected peripancreatic necrosis

Standard management of infected peripancreatic necrosis consists of open su rgical debridement and lavage-a traumatic intervention with substantial mor bidity and mortality. As an alternative and novel approach with minimum inv asiveness, we present fenestration of the gastric wall and debridement of i nfected necrosis by direct retroperitoneal endoscopy. In three patients, th is strategy led to rapid clinical improvement and no serious complications. Transgastric endoscopic therapy may be a less traumatic alternative to sur gery and should be further assessed in prospective studies.