Endoscopic ultrasound-guided drainage and necrosectomy of walled-off pancreatic necrosis using a metal stent with an electrocautery-enhanced delivery system and hydrogen peroxide

Direct endoscopic necrosectomy of walled-off pancreatic necrosis (WOPN) has recently been reported to have comparable success rates to surgery, but with lower morbidity and mortality [1] [2]. The procedure is, however, time consuming and requires multiple device exchanges [3], which may increase the risk of complications. A novel, dedicated device, the Hot AXIOS (Xlumena Inc., Mountain View, California, USA) ([Fig. 1]), has recently become available. This consists of a large-diameter, fully covered self-expanding metal stent (FCSEMS) with antimigration flanges, which is mounted on a 10.8-Fr delivery system with an electrocautery blade at its distal tip.