Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis

Abstract

Pancreatic and peripancreatic collections are the main local complications of acute pancreatitis with a high incidence. In the early phase, most acute pancreatic and peripancreatic collections can resolve spontaneously with supportive treatment. However, in some cases, they will develop into pancreatic pseudocyst (PPC) or walled-off necrosis (WON). When causing symptoms or coinfection, both PPC and WON may require invasive intervention. Compared to PPC, which can be effectively treated by endoscopic ultrasound-guided transmural drainage with plastic stents, the treatment of WON is more complicated and challenging, particularly in the presence of infected necrosis. In the past few decades, with the development of minimally invasive interventional technology especially the progression of endoscopic techniques, the standard treatments of those severe complications have undergone tremendous changes. Currently, based on the robust evidence from randomized controlled trials, the step-up minimally invasive approaches have become the standard treatments for WON. However, the pancreatic fistulae during the surgical step-up treatment and the stent-related complications during the endoscopic step-up treatment should not be neglected. In this review article, we will mainly discuss the indications of PPC and WON, the timing for intervention, and minimally invasive treatment, especially endoscopic treatment. We also introduced our preliminary experience in endoscopic gastric fenestration, which may be a promising innovative method for the treatment of WON.

The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part I

“…It should be emphasized that percutaneous drainage has a lower success rate compared to other invasive methods, which may mean the need for additional interventions or complications in the form of e.g. external fistulas [ 75 ].…”

Direct Endoscopic Necrosectomy: Timing and Technique

“…After entering the collection, the fluids and little necrotic debris are sucked through the endoscope working channel. The bigger necrotic debris and those adherent to the wall are grabbed with various devices conceived for other purposes, like polypectomy snares (Figure 4), Dormia basket, Roth basket, other stone removal baskets and forceps of various shape (grasping, tripod, rat-tooth, pelican), and released into the stomach/duodenum [13,[23][24][25]37,41,64]. In 2018 Van Der Wiel et al reported the first two cases of WOPN treated with a novel device, the EndoRotor Powered Endoscopic Debridement (PED) System ® (Interscope Medical, Inc., Worcester, MA, USA) [65] The EndoRotor ® is a through-the scope tool designed for use in the gastrointestinal tract for tissue dissection and resection, later modified to perform safely and efficaciously DEN.…”

Invasive intervention timing for infected necrotizing pancreatitis: Late invasive intervention is not late for collection

“…Recently, we published a mini-review about pancreatic and peripancreatic collections of acute pancreatitis, in which we mainly discussed treatment approaches[ 3 ]. We did not elaborate on the timing for invasive intervention due to space limitations.…”