The role of endoscopic therapy in the minimally invasive management of pancreatic necrosis

Abstract

Pancreatic necrosis is among the most frequently encountered local complications of acute pancreatitis and associates with severe disease. Infected pancreatic necrosis further enhances the risk for morbidity and mortality. Pancreatic fluid collections that result from pancreatic necrosis evolve from acute necrotic collections to walled off necrosis and are defined by their distinct characteristics on cross sectional imaging. A variety of interventions spanning multiple disciplines are available for the drainage and debridement of pancreatic necrosis. Prospective, randomized trials have identified management strategies that incorporate minimally invasive interventions as having the best outcomes for patients with symptomatic pancreatic necrosis. The scientific literature has confidently positioned endoscopic drainage and necrosectomy among the most effective interventions for patients with symptomatic walled off necrosis. Innovations such as the use of metallic stents, chemical debridement and multiple modalities for drainage of pancreatic necrosis show promise in improving outcomes for patients managed with endoscopic interventions.

Anesthesia for digestive tract endoscopy

“…Minimally invasive management of fluid collection, secondary to severe acute pancreatitis, has shown a clear benefit compared to surgery [76,77 ▪▪ ]. Several sessions are often necessary to completely drain the collections.…”

Current treatment of pancreatic pseudocysts: a systematic review

“…В некоторых многопрофильных ЛПУ совмещают использование обычной методики ТМД с УЗИ, которое называется дренированием при помощи ЭУС, с целью определения местоположения кисты и расстояния от нее до стенки кишечника [59]. Большинство исследователей пришли к выводу, что дренирование при помощи ЭУС имеет лучшие результаты в сравнении с традиционной методикой ТМД, обеспечивая более точную визуализацию псевдокисты и окружающей анатомии, что помогает оператору выбрать оптимальные места для проколов и избежать повреждения крупных сосудов [60,61].…”