Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Abstract

Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

Endoscopic Management of Giant Walled-Off Pancreatic Necrosis With a High Risk of Bleeding

“…Once large crossing vessels are identified, careful necrosectomy with interventional radiology backup should be considered to ensure safety of the procedure. 14…”

Endoscopic management of pancreatic walled-off necrosis

“…This technique starts with visualization through ultrasound technology to assess a target site. Once a location is chosen that is in contact with the gastric or duodenal walls, a 19-G needle is introduced and fluid can be aspirated from the PFC [ 25 , 29 , 31 ]. This approach was then expanded by Seifert et al , who described DEN as an adjunct procedure that can improve patient outcomes [ 32 ].…”

“…Once a suitable location for cystogastrostomy has been identified, a needle is introduced and punctures the fluid collection. A guidewire is then inserted, and a fistula is created between the lumen of the gastrointestinal tract and the PFC [ 31 ]. There are 3 different types of stents that can be inserted: plastic pigtail stents, self-expanding metal stents (SEMS), and LAMS ( Fig.…”

Drenaje de los pseudoquistes pancreáticos: endoscópico vs quirúrgico metaanálisis. ¿Es momento de la hibridación?

“…8 Existen aspectos técnicos que han sido evaluados y que tienen importancia en el pronóstico, en un ensayo clínico aleatorizado se comparó la dilatación mecánica con el uso de electrocaute-www.medigraphic.org.mx rio (Needle Knife [NK], cistotomo y esfinterotomo) encontrando mayores eventos adversos con esta última técnica, dentro de los cuales el principal es el sangrado. 9 En algunos estudios recientes se ha evaluado el uso de ST metálico autoexpandible totalmente cubierto transluminal (FCSEMS); sin embargo, no existen estudios que evalúen costo efectividad de los ST plásticos versus metálicos en PP. Se ha reportado resolución completa en 70% de los pacientes con FCSEMS con 15% de eventos adversos y 15% de migración de dispositivo.…”