M. Brand et al., Department of Medicine II, University of Würzburg, Würzburg, Germany, evaluated the technical success and safety of the OTSG Xcavator® as a tool for pancreatic necrosectomy in its first multicenter application.

During endoscopic treatment of pancreatic necrosis, sticky necrotic debris may be difficult to remove at times. The over-the-scope-grasper, which has been developed for this exact use-case, might prove useful for this and other scenarios.

Experienced endoscopists were introduced to the proper application of the device. To evaluate the technical success and other outcome parameters a predefined questionnaire was retrospectively completed by the endoscopist. Anonymized data were collected from the clinical databases and case analyses were performed on all 56 procedures.

56 procedures in 50 patients were selected from 9 centers which were performed between November 2020 and October 2021. 55 of 56 (98%) procedures had a successful technical application. 66% (n=37) of all procedures were pancreatic necrosectomies, with a preferred transgastric approach (33 transgastric vs 4 transduodenal). EUS-guided access to the necrosis cavity was achieved via LAMS (70%, n=26) or via double pigtail stents (30%, n=11). Three different types of SEMS were used. Almost all LAMS (25/26) had a small diameter (15 or 16 mm). The first necrosectomy session was performed in a mean of 35.7 days (14–90) after the beginning of pancreatitis. The technical success of necrosectomy was 97%, with a mean of 8 pieces (2-25 pieces) of necrosis removed. The mean overall procedure time was 59 min (range, 15-120 min), of which the grasper was used for a mean of 32 min (range, 10-70 min). In eight cases, an additional snare was used to pull the tissue into the grasping tool. In all cases, an irrigation pump was used to push the necrotic tissue out of the grasper. However, in 51%, removal of the endoscope was necessary to clean the device outside the patient. No moderate or severe/fatal complications were reported in any of the 56 procedures.

In addition, the device has been used to remove foreign bodies from the upper gastrointestinal tract (n=8) to clear insufficiency cavities before endoluminal vacuum therapy (n=5), and to remove blood clots (n=6), with a total success rate of 100%.

The authors conclude that the OTSG Xcavator is a promising multipurpose device. However further studies including more patients are required to properly indicate the efficacy, clinical utility, and safety of the device.