Double endosonography-guided transgastric and transduodenal drainage of infected pancreatic-fluid collections using metallic stents

A 34-year-old male was referred to our hospital for drainage of symptomatic pancreatic fluid collections (PFCs) secondary to an acute pancreatitis. He was affected by gastro-duodenal and biliary obstruction. CT scan images revealed 1 perigastric pseudocyst (well-defined wall, without necrosis content, 70 x 120 mm) and 1 periduodenal walled-off pancreatic necrosis (WOPN) (thickened wall, partially liquefied collection containing solid content, 80 x 90 mm). Both PFC were accessed under endoscopic ultrasound (EUS)-guidance with a 6 Fr-cystotom and dilation tract using a 10 mm balloon (Fig. 1). First, the pseudocyst was drained transgastrically with a fully covered SEMS with bilateral anchor Double endosonography-guided transgastric and transduodenal drainage of infected pancreatic-fluid collections using metallic stents