Endoscopic Drainage of Pancreatic Fluid Collections

Elmunzer, B. Joseph

doi:10.1016/j.cgh.2018.03.021

Cited by 38 publications

(41 citation statements)

References 90 publications

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“…After approximately 4 weeks, PFC becomes mature with a well‐defined inflammatory wall (PP and WON), and it is appropriate to perform endoscopic intervention when mature PFC continues to grow in size or become symptomatic . Endoscopic ultrasonography (EUS)‐guided transmural drainage has been proven to be effective and less invasive compared with surgical interventions with the great advancement in endoscopic and imaging techniques, which has been gradually accepted as the first‐line treatment for PFC …”

Section: Introductionmentioning

confidence: 99%

“…3 Endoscopic ultrasonography (EUS)-guided transmural drainage has been proven to be effective and less invasive compared with surgical interventions [4][5][6] with the great advancement in endoscopic and imaging techniques, which has been gradually accepted as the first-line treatment for PFC. 7,8 Currently, options of transmural placed stents for drainage mainly include plastic stent (PS), fully covered self-expanding metal stent (FCSEMS), and newly emerging lumen-apposing metal stent (LAMS). There are limited data comparing clinical efficacy and safety among these three types of stents, and the results of current studies seemed to be confusing.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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Background and Aim Endoscopic transmural drainage has been recognized as the first‐line treatment for pancreatic fluid collection (PFC). Currently, three different types of stents have been extensively applied, including double pigtail plastic stent (PS), fully covered self‐expanding metal stent (FCSEMS), and novel lumen‐apposing metal stent (LAMS). Nonetheless, limited data are available about the comparison among them in terms of their clinical outcomes and safety for endoscopic ultrasound‐guided drainage of PFC. Methods The current retrospective study was carried on 160 PFC patients undergoing endoscopic ultrasound‐guided drainage from 2010 to 2018 at a single tertiary care center. Patients were divided into three groups based on different drainage ways: drainage using PS, FCSEMS, or LAMS. Results A total of 160 PFC patients (104 male and 56 female) were analyzed in this retrospective study, including 62 patients drained with PS, 28 with FCSEMS, and 70 with LAMS. Typically, the technical success (93.5% vs 96.4% vs 94.3%, P = 1.000) and treatment success rates (84.6% vs 85.2% vs 89.2%, P = 0.763) were similar between PS, FCSEMS, and LAMS. With regard to major adverse events, four patients (FCSEMS: n = 2 and LAMS: n = 2) with pseudoaneurysms developed severe bleeding; among them, 75% (3/4) of patients were observed within 2 weeks after intervention, and two patients in LAMS group died. Conclusions There are no significant differences in the clinical outcomes of PFC patients treated with PS, FCSEMS, or LAMS. Nonetheless, severe (or even fatal) bleeding may occur at the early stage after metal stent placement, which should be paid particular attention to.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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“…ETD of PFCs is safe, and major complications are uncommon. Complications related to ETD occur in 10-40% of patients with WON [22]. Supra-infection of the cyst cavity is the most common significant complication associated with ETD.…”

Section: Endoscopic Drainage Of Pfcsmentioning

confidence: 99%

“…Trans-papillary drainage (TPD) of PFCs may be useful in certain scenarios as follows: (a) small size of cyst (<5 cm) communicating with main pancreatic duct (PD), (b) as an adjunct to ETD in cases with PD leak or disconnected PD, (c) chronic pancreatitis with an obstructed PD communicating with a pseudocyst, and (d) management of external pancreatic fistula after percutaneous or surgical drainage [22]. When used as a primary modality, TPD provides the path of least resistance for the pancreatic juice, thereby diverting it away from the cyst.…”

Section: Trans-papillary Drainage Of Pfcsmentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collections: An Update

Nabi¹,

Reddy²

2019

Pancreatitis

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Pancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. PFCs have been categorized according to their content and duration after an episode of pancreatitis. Acute collections (<4 week) and asymptomatic late collections (>4 weeks) can be usually managed conservatively. Late collections including walled off necrosis (WON) and pancreatic pseudocysts (PP) have a well-defined wall. Consequently, it is easier and safer to drain these collections when required. The most common indication to drain PFCs is infection and the available means of drainage include surgical, endoscopic, and percutaneous. Open surgical interventions carry a high risk of morbidity and mortality. Therefore, in the current era, a step up approach is preferred to minimize morbidity over the more aggressive surgical treatments. Endoscopic step-up approach is effective and favored over minimally invasive surgical or percutaneous drainage due to reduced risk of organ failure and external pancreatic fistula. However, the approach to PFCs should be individualized for optimal outcomes. A small subgroup of patients does not respond to endotherapy or percutaneous interventions and requires open surgical debridement. Similarly, not all PFCs are amenable to endoscopic drainage and demand alternative modalities like percutaneous or minimally invasive surgical drainage.

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“…Furthermore, EUS is not only a diagnostic approach but a therapeutic one. PFCs are being identified at an increasing frequency, mainly due to the enhanced use of abdominal imaging approaches[ 26 ].…”

Section: What Are Pancreatic Fluid Collections?mentioning

confidence: 99%

Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections

Xie

2018

WJCC

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Pancreatic fluid collections (PFCs), common sequelae of acute or chronic pancreatitis, are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification. Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC. EUS-guided drainage is effective and successful; it has a technical success rate of 90%-100% and a clinical success rate of 85%-98%. Recent studies have shown a 5%-30% adverse events (AEs) rate for the procedure. The most common AEs include infection, hemorrhage, perforation and stent migration. Hemorrhage, a severe and sometimes deadly outcome, requires a well-organized and appropriate treatment strategy. However, few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC. Establishing a practical therapeutic strategy is an essential and significant step in standardized management. The aim of this review is to describe the current situation of EUS-guided drainage of PFCs, including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives. We propose a novel and meaningful algorithm for systematically managing hemorrhage events. To our limited knowledge, a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.

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Endoscopic Drainage of Pancreatic Fluid Collections

Cited by 38 publications

References 90 publications

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Endoscopic Management of Pancreatic Fluid Collections: An Update

Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections

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