Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts

Practice Guidelines in Acute Pancreatitis

“…The second type of pancreatic pseudocyst is that which takes place within the confines of the pancreas and involves pancreatic necrotic tissue with variable amounts of pancreatic fluid. This entity, frequently termed "organized necrosis" (166), is a distinct clinical entity that poses substantially greater management challenges (167). Additional terminology will be needed to separate these two conditions.…”

“…This technique has not been compared to surgical debridement and requires a dedicated team of skilled radiologists who are willing to place at least one or more large bore drains, be available at all times for supervision of irrigation of catheters, exchange or upsizing of catheters because of inadequate drainage of infected material, and placement of new catheters as indicated. Finally, endoscopic drainage, as applied to sterile necrosis, may occasionally be applicable to selected patients with infected necrosis, but should be approached with caution (166,195) (see Treatment Guideline VI).…”

“…If surgery is delayed for at least 2-3 wk, the diffuse inflammatory process in the retroperitoneum resolves considerably, and gives rise to an encapsulated structure that envelops the necrotic pancreas and peripancreatic area (166). This structure has frequently been called organized necrosis.…”

“…The technique includes puncture of the intervening gastric (or duodenal) wall with an instrument introduced through a duodenoscope or echo-endoscope, followed by endoscopic balloon dilation to enlarge the opening, retrieval of necrotic material and evacuation of fluid, often requiring direct endoscopic entry into the cavity and mechanical evacuation of solid contents, and insertion of double pigtail catheters between the stomach (or duodenum) and the cavity to maintain drainage. Repeated endoscopic debridements and/or prolonged nasocystic lavage of the cavity are often required (166,196). While this technique appears to have a high success rate in limited reports, complications including infection and need for surgery have been noted in up to 37% of cases (166,196).…”

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

“…3), and fluid leakage. [18][19][20][21] Historically, PFCs needing drainage have been managed either with surgical or percutaneous intervention. Surgical cystogastrostomy can be either open or laparoscopic and involves the anastomosis of the cyst with the gastric lumen or in some instances with the small bowel (cystojejunostomy).…”