Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification

Abstract

Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated. Within the last decade, endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage. Proper understanding of anatomic landmarks, including assessment of the main pancreatic duct and any associated lesions – such as disruptions and strictures – are key to achieving clinical success, reducing the need for reintervention or recurrence, especially in cases with suspected disconnected pancreatic duct syndrome. Additionally, proper review of imaging and anatomic landmarks, including collection location, are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents. Pancreatography to adequately assess the main pancreatic duct may be performed by two methods: Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopan-creatography. Despite the critical need to understand anatomy via pancrea-tography and assess the main pancreatic duct, a standardized approach or uniform assessment strategy has not been described in the literature. Therefore, the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.

Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial

“…Based on our experience, Wirsungraphy classification helps to standardize the assessment of the MPD and to guide possible approaches [24]. In the included population, we observed a large number of cases with complete MPD disjunction (type IV), which represented almost 66% of the Wirsungraphys performed.…”

“…Procedure time was measured from time to FNA puncture to stent deployment. Endoscopic pancreatography findings were documented according to the Lera-Proença classification (Figure 2) [24].…”

Pancreatitis after endoscopic retrograde cholangiopancreatography: A narrative review

“…It is also known that prolonged manipulation around the papillary orifice, inadvertent cannulation of the pancreatic duct and multiple injections into the pancreatic duct are common when selective cannulation of the bile duct is difficult[ 9 , 10 ]. This can result in mechanical damage to the duct or ampoule.…”

Current treatment of pancreatic pseudocysts: a systematic review

“…Существуют многочисленные классификации псевдокист поджелудочной железы, в том числе классификация D'Egidio и Schein (цитируется по D. T. H. Moura et al (2020)) [13] от 1991 года, в которой псевдокисты были классифицированы на основе этиологии острого или хронического панкреатита, анатомии главного панкреатического протока поджелудочной железы и наличия связи между кистой и главным панкреатическим протоком поджелудочной железы. Исходя из этой классификации киста может быть разделена на три различных типа: В 2015 году на основе большого ретроспективного исследования -893 пациентов с псевдокистой поджелудочной железы -G. Pan et al (2015) предложили новую классификацию, основанную на топографической характеристике и клиническом проявлении псевдокист и связи между кистой и главным панкреатическим протоком [9] (табл.…”