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. 2020 Nov 7;26(41):6431–6441. doi: 10.3748/wjg.v26.i41.6431

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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/

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Case 1 (failed fenestration) with indwelling nasal-cyst drainage tube. A: Closely connected walled-off necrosis (WON) and gastric wall (preoperative computed tomography scan); B: Smooth, compressive indentation of stomach by WON; C: Endoscopic ultrasound (EUS) showed closely connected WON and gastric wall (with clear layers, red arrow); D and E: Incising the selected sites layer by layer by an endoscopic submucosal dissection approach; F: Nonadherence of WON and stomach after incising gastric muscularis propria; G: WON mobilization far from fenestration site (orange arrow) under EUS guidance; H: Needle puncture into WON from gastric wall; I: Visible separation of WON and stomach by X-ray fluoroscopy after inserting the guidewire into WON; J: Indwelling nasal-cyst drainage tube passed through the stomach into WON and closing the incised gastric muscularis propria by metal clips; K and L: Nasal-cyst drainage tube was cut off and we reverted to internal drainage 15 d later.