Endoscopic Management of Acute Pancreatitis

Endoscopic Treatment of Pancreatic Diseases

“…Several comprehensive reviews discussing indications, timing, standard and novel approaches, outcomes, and complications regarding ETD and necrosectomy in infected necrotizing pancreatitis have been published recently [2,3,38,39,[42][43][44][45][46][47]. The technique of endoscopic transluminal necrosectomy (ETN) involves a transmural (transgastric or transduodenal) access to the WOPN, followed by large-caliber balloon dilation of the tract between the collection and the gastrointestinal wall, allowing the insertion of an endoscope into the collection to visualize the necrotic material, mechanical debridement, and lavage.…”

“…Patients with idiopathic AP should be evaluated at specialized centers on pancreatic diseases, applying combined multidisciplinary approach, including advanced endoscopy [1]. Various anatomic (pancreas divisum, anomalous anomalous pancreatobiliary duct junction, choledochal cysts/ choledochocele, periampullarry diverticulae, ampullary tumors) and physiologic anomalies (sphincter of Oddi dysfunction/SOD) can contribute to recurrent episodes of AP and many of them can often be diagnosed and treated endoscopically [3,64,65]. The diagnostic role of ERCP can help define specific causative factors in patients with idiopathic AP, but its major limitation is the risk of post-ERCP pancreatitis, which varies from 5% to 10% and reaches 30% in cases with SOD.…”

“…Treatment of most other choledochal cysts is mostly surgical because for their potential of malignant degeneration [3]. The presence of periampullary diverticulum, although rarely, can also be a cause for acute relapsing pancreatitis.…”

“…Pancreatic cancer should be suspected in any patient >40 years of age with idiopathic pancreatitis, especially those with a prolonged or recurrent course [72]. Ampullary tumors can be resected either surgically or endoscopically [3]. It was reported that endoscopic treatment (snare polypectomy with sphincterotomy) was successful in the removal of ampullary tumors with no ductal invasion in up to 90% of cases [73,74].…”

“…Both ANCs or WOPN can be sterile or infected. Severe AP is estimated to occur in up to 20% of patients and is associated with high morbidity and mortality (approximately 15%) due to the development of sterile or infected necrosis, sepsis, and progressive multisystem organ failure [3,4]. Development of infected necrosis is observed in 25%-70% of patients with necrotizing disease and usually requires an intervention to control the sepsis [5,6].…”