Management of pancreatic fluid collections

Abstract

Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study

“…Odds LAMS, lumen-apposing metal stent; DPPS, double-pigtail plastic stent. 1 Results adjusted for eventual center-effects using random-effects logistic regression.…”

“…Endoscopic ultrasound (EUS)-guided drainage has become the standard of care for the treatment of symptomatic pancreatic fluid collections (PFCs), including pancreatic pseudocysts (PPCs) and walled-off necrosis (WON). While PPCs are managed mainly by the placement of double-pigtail plastic stents (DPPSs), the introduction of lumen-apposing fully covered metal stents (LAMSs) has substantially increased the ability to treat necrotic collections [1]. Moreover LAMSs facilitate, when needed, direct endoscopic necrosectomy (DEN) [2,3].…”

Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series

“…Furthermore, EUS allows to clearly identify PCF, measure it, and evaluate the distance between it and the gastric wall. It reduces risk of complications such as puncture of other structures as blood-vessels thanks to the possibility of identifying them [ 28 , 29 ].…”

Endoscopic management of pancreatic walled-off necrosis

“…In many cases, acute PFCs will resolve spontaneously and do not require intervention [ 18 ]. Drainage is recommended in patients who develop symptoms including persistent pain; signs of gastric outlet obstruction such as nausea, vomiting or early satiety; or signs of biliary obstruction such as jaundice [ 19 ]. To this end, the presence of a PFC alone is not an indication for drainage; however, PFCs larger than 6 cm are often symptomatic, thus requiring drainage [ 20 , 21 ].…”