Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Overview

Journal Clin Endosc

Date 2017 Apr 11

PMID 28391671

Citations 17

Authors

Ali Alali

Jeffrey Mosko

Gary May

Christopher Teshima

Affiliations

Soon will be listed here.

Abstract

Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

Citing Articles

Turkish Society of Gastroenterology: Pancreas Working Group, Acute Pancreatitis Committee Consensus Report.

Ogutmen Koc D, Bengi G, Gul O, Ozen Alahdab Y, Altintas E, Barutcu S Turk J Gastroenterol. 2024; 35(Suppl 1):S1-S44.

PMID: 39599919 PMC: 11670795. DOI: 10.5152/tjg.2024.24392.

Video-assisted retroperitoneal debridement for necrotizing pancreatitis: a single center experience in Colombia.

Rey Chaves C, Azula Uribe M, Benavides Largo S, Becerra Sarmiento L, Gomez-Gutierrez M, Cuevas Lopez L BMC Surg. 2024; 24(1):293.

PMID: 39375651 PMC: 11457398. DOI: 10.1186/s12893-024-02586-x.

Safety and efficacy of early versus late removal of LAMS for pancreatic fluid collections.

Willems P, Esmail E, Paquin S, Sahai A Endosc Int Open. 2024; 12(2):E317-E323.

PMID: 38420155 PMC: 10901640. DOI: 10.1055/a-2226-0840.

Assessing the Impact of Medication and Stenting on the Quality of Life of Patients With Chronic Pancreatitis: A Prospective Study.

Rajput R, Prasad S D, Pai C Cureus. 2024; 15(12):e50106.

PMID: 38186534 PMC: 10771073. DOI: 10.7759/cureus.50106.

Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study.

Wei W, Tang Y, Peng Z, Xie J, Deng Z, Yuan T Eur J Med Res. 2023; 28(1):72.

PMID: 36755332 PMC: 9909852. DOI: 10.1186/s40001-023-01030-9.

References

Varadarajulu S, Wilcox C . Endoscopic placement of permanent indwelling transmural stents in disconnected pancreatic duct syndrome: does benefit outweigh the risks?. Gastrointest Endosc. 2011; 74(6):1408-12. DOI: 10.1016/j.gie.2011.07.049. View

Smith I, Gutierrez J, Ramesh J, Wilcox C, Monkemuller K . Endoscopic extra-cavitary drainage of pancreatic necrosis with fully covered self-expanding metal stents (fcSEMS) and staged lavage with a high-flow water jet system. Endosc Int Open. 2015; 3(2):E154-60. PMC: 4477029. DOI: 10.1055/s-0034-1391481. View

Gardner T, Chahal P, Papachristou G, Vege S, Petersen B, Gostout C . A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc. 2009; 69(6):1085-94. DOI: 10.1016/j.gie.2008.06.061. View

Trevino J, Tevino J, Tamhane A, Varadarajulu S . Successful stenting in ductal disruption favorably impacts treatment outcomes in patients undergoing transmural drainage of peripancreatic fluid collections. J Gastroenterol Hepatol. 2010; 25(3):526-31. DOI: 10.1111/j.1440-1746.2009.06109.x. View

Siddiqui A, Kowalski T, Loren D, Khalid A, Soomro A, Mazhar S . Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc. 2016; 85(4):758-765. DOI: 10.1016/j.gie.2016.08.014. View

Deviere J, Bueso H, Baize M, Azar C, Love J, Moreno E . Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc. 1995; 42(5):445-51. DOI: 10.1016/s0016-5107(95)70048-x. View

Shah R, Shah J, Waxman I, Kowalski T, Sanchez-Yague A, Nieto J . Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol. 2014; 13(4):747-52. DOI: 10.1016/j.cgh.2014.09.047. View

Sharaiha R, Tyberg A, Khashab M, Kumta N, Karia K, Nieto J . Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol. 2016; 14(12):1797-1803. DOI: 10.1016/j.cgh.2016.05.011. View

Varadarajulu S, Bang J, Sutton B, Trevino J, Christein J, Wilcox C . Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013; 145(3):583-90.e1. DOI: 10.1053/j.gastro.2013.05.046. View

10.

Gomatos I, Halloran C, Ghaneh P, Raraty M, Polydoros F, Evans J . Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis. Ann Surg. 2015; 263(5):992-1001. DOI: 10.1097/SLA.0000000000001407. View

11.

Hookey L, Debroux S, Delhaye M, Arvanitakis M, Le Moine O, Deviere J . Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006; 63(4):635-43. DOI: 10.1016/j.gie.2005.06.028. View

12.

Fabbri C, Luigiano C, Cennamo V, Polifemo A, Barresi L, Jovine E . Endoscopic ultrasound-guided transmural drainage of infected pancreatic fluid collections with placement of covered self-expanding metal stents: a case series. Endoscopy. 2012; 44(4):429-33. DOI: 10.1055/s-0031-1291624. View

13.

Sharaiha R, Defilippis E, Kedia P, Gaidhane M, Boumitri C, Lim H . Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc. 2015; 82(5):822-7. DOI: 10.1016/j.gie.2015.02.035. View

14.

Bang J, Wilcox C, Trevino J, Ramesh J, Hasan M, Hawes R . Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc. 2014; 28(10):2877-83. DOI: 10.1007/s00464-014-3541-7. View

15.

Gardner T, Coelho-Prabhu N, Gordon S, Gelrud A, Maple J, Papachristou G . Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc. 2011; 73(4):718-26. DOI: 10.1016/j.gie.2010.10.053. View

16.

Bradley E, CLEMENTS Jr J, Gonzalez A . The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979; 137(1):135-41. DOI: 10.1016/0002-9610(79)90024-2. View

17.

Mier J, Leon E, Castillo A, Robledo F, Blanco R . Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg. 1997; 173(2):71-5. DOI: 10.1016/S0002-9610(96)00425-4. View

18.

Sarathi Patra P, Das K, Bhattacharyya A, Ray S, Hembram J, Sanyal S . Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg. 2014; 101(13):1721-8. DOI: 10.1002/bjs.9666. View

19.

Seifert H, Biermer M, Schmitt W, Jurgensen C, Will U, Gerlach R . Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut. 2009; 58(9):1260-6. DOI: 10.1136/gut.2008.163733. View

20.

Mouli V, Sreenivas V, Garg P . Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology. 2012; 144(2):333-340.e2. DOI: 10.1053/j.gastro.2012.10.004. View