Endoscopic management of pancreatic fluid collections-revisited

Abstract

The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

Drenaje trans-gastrico de pseudoquiste pancreático en paciente pediátrico

“…Tiene una tasa de éxito en aproximadamente el 86%-100% de los casos. En una revisión sistemática que comparaba el drenaje del pseudoquiste pancreático por vía endoscópica, percutánea y quirúrgica se concluyó que tanto el drenaje endoscópico como quirúrgico son igualmente eficaces, con una estancia hospitalaria más corta, menor costo y mejor calidad de vida en el grupo endoscópico; sin embargo, el drenaje quirúrgico o percutáneo se puede considerar en pacientes con anatomía desaprobada (15).…”

Endoscopic Management of Pancreatic Fluid Collections: An Update

“…The technique of endoscopic drainage of PFCs involves the following steps: puncture of the cysto-gastric or cysto-duodenal wall using a 19 gauge needle and aspiration of cyst contents, coiling of guidewire within the cyst cavity under fluoroscopy guidance, dilatation of the tract using cystotome and balloon and deployment of plastic or metal endoprostheses. EUS guided drainage is preferred to endoscopic approach as intervening vessels can be avoided and non-bulging collections can be targeted under vision [10].…”

“…The development of novel LCMS has widened the therapeutic armamentarium for ETD of PFCs. Newly developed LCMS have either lumen apposing (AXIOS, Xlumena, Mountain View, CA, United States and Niti-S SPAXUS, TaeWoong Medical Co., Ltd., Ilsan, South Korea) properties or flared ends (NAGI, Taewoong Medical Co, Ilsan, South Korea) to prevent stent migration [10]. As compared to the conventional metal stents, the use of LCMS is associated with superior outcomes in terms of number of procedures required for the resolution of WON [26].…”

Methods of Treatment of Post-Necroctic Pancreatic Cysts: Modern Look at the Problem (Literature Review)

“…Второй по частоте причиной образования псевдокист является травма поджелудочной железы, при которой псевдокисты формируются в 10 % случаев [6]. Стоит отметить, что хронический панкреатит осложняется формированием кистозных образований в 20-40 % случаев [1,9,35].…”

“…Транскутанная пункция является доста-точно безопасным и простым в выполнении методом малоинвазивного лечения, не требующим системной анестезии. Ещё одним немаловажным качеством, Surgery которым обладает транскутанная пункция, является выполнение её у пациентов, имеющих тяжёлую со-путствующую патологию, практически без рисков развития серьёзных послеоперационных осложнений [4,9,34,35,38]. В последнее время наметились огра-ниченные показания для её выполнения, что связано с большой частотой рецидивов ПКПЖ (до 40 %) [34,38].…”