The PEN technique consists of percutaneous puncture of the pancreatic necrotic collection from retroperitoneal, or less frequently, transperitoneal access, under ultrasound or CT guidance. Next, a fully-coated, self-expandable esophageal stent is inserted across the puncture, with its distal end reaching the necrotic collection lumen and its proximal end located outside the patient’s body. During PEN, a flexible endoscope (usually a gastroscope) is inserted along the esophageal stent lumen and necrosectomy (mechanical evaluation of necrotic debris from the cavity) is performed using various endoscopic instruments. During the procedure, the cavity is extensively flushed, usually with physiological saline, and the contents are aspirated. If subsequent PEN procedures are required, the esophageal stent is retained in the percutaneous location, with the introduction of plastic endoprostheses or drainage tubes along its lumen for passive or active post-procedural drainage of the necrotic collection, respectively. After the completion of endoscopic treatment using percutaneous access, the esophageal stent is removed and the site is secured with an ostomy pouch to collect the residual contents of the necrotic cavity.

Jagielski, M.; Chwarścianek, A.; Piątkowski, J.; Jackowski, M. Percutaneous Endoscopic Necrosectomy—A Review of the Literature. J. Clin. Med. 2022, 11, 3932. https://doi.org/10.3390/jcm11143932

This entry is adapted from the peer-reviewed paper 10.3390/jcm11143932