Percutaneous endoscopic necrosectomy for extensive walled-off necrosis using two endoscopes simultaneously: a report of two cases.

Endoscopic step-up approach, which involves endoscopic ultrasound-guided drainage followed by necrosectomy, has been suggested as a potentially advantageous alternative to the surgical step-up approach for walled-off necrosis (WON) following acute pancreatitis. Recent studies indicate that although there is no significant difference in major complications or mortality between the two approaches, the endoscopic step-up approach is often preferred due to shorter hospital stays and lower re-intervention rates. However, a multidisciplinary approach should be considered for complex cases. Transgastric or transduodenal approaches can be challenging in cases of extensive intra-abdominal WON, whereas percutaneous endoscopic necrosectomy (PEN) has been reported as a safe and effective minimally invasive technique. We report the cases of two critically ill patients with extensive WON and uncontrolled sepsis who were successfully treated with simultaneous dual-endoscopic PEN. This approach may offer a promising strategy for enhancing treatment efficacy in extensive WON when performed appropriately.