Hydrogen Peroxide as an Adjunctive Therapy for Walled-Off Pancreatic Necrosis During Direct Endoscopic Necrosectomy: A Solution to the Problem or a Problematic Solution?

Nearly 25 years after its initial description, endoscopic therapy of walled-off pancreatic necrosis has become widely accepted. Endoscopic therapy is composed of transmural placement of stents, now most commonly lumen-apposing metal stents and removal of solid debris, if needed. Removal of solid debris can be achieved with irrigation provided by percutaneously or endoscopically placed (nasocystic) tubes or by mechanically through direct necrosectomy. This editorial provides commentary on the use of hydrogen peroxide instilled at the time of direct necrosectomy for treatment of walled-off pancreatic necrosis.