Endoscopic management of pancreatic walled-off necrosis

Abstract

Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.

Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials

“…Recent studies have shown that minimally invasive surgery (MIS) can effectively treat such conditions. Specifically, laparoscopic cystogastrostomy with internal debridement has been found to be superior to open surgical necrosectomy with internal debridement performs better than open surgical necrosectomy [ 8–12 ]. During the endoscopic drainage procedure, an internal endoprosthesis is inserted endoscopically to facilitate transluminal drainage.…”