Endoscopic Management of Pancreatic Fluid Collections

Dorrell, Robert; Pawa, Swati; Pawa, Rishi

doi:10.3390/jcm10020284

Cited by 21 publications

(27 citation statements)

References 61 publications

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“…The main AEs using FCSEMS are: stent migration, bleeding from the fistulous tract, stent migration and injury of the duodenal/gastric wall or of the retroperitoneum, resulting in bleeding and/or perforation [9,41].…”

Section: Fully Covered Self-expandable Metal Stentsmentioning

confidence: 99%

“…This represents a second-generation device, implemented with a cautery tip for the fistula creation. The new system simplifies the delivery of the LAMS by immediate one-step procedure, without the need of an access for needle plus guidewire, or further dilation of the fistula [41].…”

Section: Lumen-apposing Metals Stents (Lamss) Technical Aspects Of Lamssmentioning

confidence: 99%

“…The first preliminary step to perform DEN is the localization of the most appropriate site to practice the cystoenterostomy (usually posterior gastric or median duodenal wall) [57]. This should always be conducted under EUS assistance, since it allows one to evaluate the extent of the collection, the amount of solid vs. liquid material, thickness of the wall, and the presence of interposed structures and blood vessels (using the Doppler flow guidance) [13,41,58]. In addition, if needed, it allows one to perform FNA with subsequent culture or GRAM stain, and to inject contrast to visualize the cavity under fluoroscopy [13,41,59].…”

Section: Technical Aspectsmentioning

confidence: 99%

“…This should always be conducted under EUS assistance, since it allows one to evaluate the extent of the collection, the amount of solid vs. liquid material, thickness of the wall, and the presence of interposed structures and blood vessels (using the Doppler flow guidance) [13,41,58]. In addition, if needed, it allows one to perform FNA with subsequent culture or GRAM stain, and to inject contrast to visualize the cavity under fluoroscopy [13,41,59]. The next step is different, depending on the kind of stent used:…”

Section: Technical Aspectsmentioning

confidence: 99%

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Direct Endoscopic Necrosectomy: Timing and Technique

Pinto

Bellizzi²,

Badas

et al. 2021

Medicina

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Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

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Section: Fully Covered Self-expandable Metal Stentsmentioning

confidence: 99%

Section: Lumen-apposing Metals Stents (Lamss) Technical Aspects Of Lamssmentioning

confidence: 99%

Section: Technical Aspectsmentioning

confidence: 99%

Section: Technical Aspectsmentioning

confidence: 99%

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Direct Endoscopic Necrosectomy: Timing and Technique

Pinto

Bellizzi²,

Badas

et al. 2021

Medicina

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“…Лапароскопическое вмешательство может быть выполнено с использованием переднего или заднего (через сальниковую сумку) доступа к желудку, использование того или иного метода основано на опыте оператора [42]. В исследовании, включающем 83 пациента, проведенном R. Dorrell et al (2021) [43], был сделан вывод, что лапароскопическая цистогастростомия имела более высокий процент успешности лечения по сравнению с эндоскопической цистогастростомией. Из 45 пациентов, перенесших ЭД, 22 пациентам (48,9%) потребовалось повторное лечение (хирургическая цистогастростомия, транскутанное дренирование или повторное эндоскопическое дренирование) для получения таких же успешных результатов, как и при лапароскопическом дренировании.…”

Section: хирургическое дренированиеunclassified

Current treatment of pancreatic pseudocysts: a systematic review

Durleshter¹,

Генрих

Макаренко³

et al. 2021

Kuban. nauсh. med. vestnik

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Background. Pancreatic pseudocysts stand among current challenges in modern medicine. Their treatment uses variant instrumental techniques and implies a multispecialty approach. Trials in surgery and gastroenterology have aimed to identify an optimal strategy to tackle pancreatic pseudocysts for reducing complications and the recurrence rate, suggesting ultrasound-guided percutaneous, laparoscopic and flexible endoscopic drainage as promising treatment choices.Objectives. A summarising review of diagnostic and therapeutic methods for pancreatic pseudocyst treatment and comparison of ultrasound-guided percutaneous vs. surgical and endoscopic drainage techniques.Methods. The review examines the classification, epidemiology and methods for diagnosis and treatment of pancreatic pseudocysts. Only comparative full-text studies published within 2014–2021, as well as selected impactive publications within 2002–2013, have been included. The eLibrary, Elsevier and PubMed resources were queried for the article or journal title fields against the keywords (separate or combined) “pancreatic pseudocyst” [псевдокиста поджелудочной железы], “pseudocyst drainage” [дренирование псевдокисты], “surgical drainage” [хирургическое дренирование], “endoscopic drainage” [эндоскопическое дренирование], cystogastrostomy [цистогастростомия], gastrojejunostomy [гастроеюностомия], “duodenal-cystic anastomosis” [цистодуоденоанастомоз], “transpapillary drainage” [транспапиллярное дренирование], “transmural drainage and esophagogastroduodenoscopy” [трансмуральное дренирование и эзофагогастродуоденоскопия]. Records have been selected for topic-related scientific value.Results. The review systematically surveys 68 scientific papers in the focus area and summarises the most common surgical methods for pancreatic pseudocyst treatment. Based on the main principle, the methods are classified into three categories, ultrasound-guided percutaneous drainage, surgical drainage and flexible endoscopic drainage. The major classifications and treatment techniques are highlighted for their advantages and disadvantages.Conclusion. There exist no generally adopted strategy for pancreatic pseudocyst treatment in current clinical practice and no evidence on a particular method application in a large patient cohort. The publication survey identifies the techniques of percutaneous, surgical and endoscopic drainage with ultrasound control as highly effective overall among other surgical treatments.

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Delayed endoscopic necrosectomy improves hospital length of stay and reduces endoscopic interventions in patients with symptomatic walled‐off necrosis

et al. 2022

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Objectives Advancements in the endoscopic management of walled‐off necrosis using lumen apposing metal stents have improved outcomes over its surgical and percutaneous alternatives. The ideal procedural technique and timing of direct endoscopic necrosectomy (DEN) have yet to be clarified. Methods From November 2015 to June 2021, a retrospective comparative cohort analysis was performed comparing clinical outcomes for patients undergoing immediate DEN (iDEN) versus delayed DEN (dDEN). Subgroups were identified based on the quantification of necrosis. Wilcoxon two‐sample tests were used to compare continuous variables and Fisher's exact test was used to compare categorical variables. Results A total of 80 patients underwent DEN for management of walled‐off necrosis (iDEN = 43, dDEN = 37). Technical success was achieved in all patients. Clinical success was seen in 39 (91%) patients in the iDEN group and 34 (92%) in the dDEN group. Amongst iDEN patients, the mean number of necrosectomies was 2.5 (standard deviation [SD] 1.4) in comparison to 1.5 (SD 1.0) for dDEN (p‐value = 0.0011). The median index hospital length of stay was longer with iDEN than dDEN (7.5 days vs. 3.0 days respectively, p‐value = 0.010). Subgroup analysis was performed based on the percentage of necrosis (<25% vs. >25% necrosis). iDEN was associated with more necrosectomies than dDEN regardless of the percentage of necrosis (p = 0.017 and 0.0067, respectively). Conclusion Patients undergoing dDEN had a shorter index hospital stay and fewer necrosectomies than iDEN. The large diameter of lumen apposing metal stents permits adequate drainage allowing a less aggressive approach thereby improving clinical outcomes and avoiding unnecessary interventions.

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Endoscopic Management of Pancreatic Fluid Collections

Cited by 21 publications

References 61 publications

Direct Endoscopic Necrosectomy: Timing and Technique

Direct Endoscopic Necrosectomy: Timing and Technique

Current treatment of pancreatic pseudocysts: a systematic review

Delayed endoscopic necrosectomy improves hospital length of stay and reduces endoscopic interventions in patients with symptomatic walled‐off necrosis

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