Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Alali, Ali; Mosko, Jeffrey D.; May, Gary R.; Teshima, Christopher

doi:10.5946/ce.2017.045

Cited by 46 publications

(78 citation statements)

References 55 publications

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“…Significant procedural morbidity and mortality has been reported; hence percutaneous and endoscopic drainage techniques have overtaken traditional open approaches to pancreatic pseudocysts. Compared to surgery, randomized control trials have confirmed that an endoscopic approach is safer and associated with lower costs, shorter hospital stay, and improved quality of life . Owing to its heterotopic position and jejunal drainage, endoscopic drainage often is not technically feasible/accessible in the transplant pancreas.…”

Section: Discussionmentioning

confidence: 99%

“…Indications for intervention in native pancreatic pseudocysts include infected pseudocysts, symptoms related to the pseudocyst size or position, and failure to regress. Size on its own is seldom a sole indication to intervene . We performed cystojejunostomy on 1 patient due to failure of repeated percutaneous drainage attempts and documented communication with the main pancreatic duct (patient 20).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

Al‐Qaoud

Martinez

Sollinger

et al. 2018

American Journal of Transplantation

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Literature on the behavior of cystic lesions in pancreas transplants is scarce, and hence a better understanding is warranted. Data on recipients and their respective donors that underwent simultaneous kidney and pancreas, pancreas transplant alone, and pancreas after kidney between 1994 and 2015 were reviewed (n = 1185). Cystic lesions of the transplant pancreas developed in 22 patients (1.8%): 12 pseudocysts, 2 cysts/remnants, 4 intraductal papillary mucinous neoplasms (IPMN), 2 adenocarcinomas, 1 low-grade intraepithelial pancreatic neoplasia, and 1 case of polycystic kidney disease. The median size was 3.6 cm (1.6-5.5 cm), and occurred at a median time of 65.5 months (2-183 months) posttransplant. The median age of the graft at time of diagnosis was 42 years (25.7-54.5), with 17 of 22 grafts (77%) functioning at time of diagnosis. Triggers for investigation were elevations in pancreatic enzymes, re-admissions for abdominal pain, and incidentalomas. High-resolution imaging and diagnostic biopsy/aspiration with ancillary tests were the main diagnostic tests. Most pseudocysts were managed by percutaneous drainage, and although no firm inference can be made from such a small series, we have observed that the behavior and management of IPMN and adenocarcinoma in the pancreas graft appears congruent to that of the native pancreas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

Al‐Qaoud

Martinez

Sollinger

et al. 2018

American Journal of Transplantation

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“…Another fact that should be taken into account is the existence of submucosal vessels or true varicose veins that are not infrequently associated and that may be interposed between the gastric wall and the cyst. The use of color Doppler helps to identify these structures and maneuver the echoendoscope in order to avoid them when it comes to puncture (26).…”

Section: Discussionmentioning

confidence: 99%

EUS-Guided Transgastric Drainage of Intraabdominal Fluid Collections

Ilie¹,

Opriță²,

Șandru³

et al. 2018

chr

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Rezultate: Vârsta medie a subiecţilor incluşi în studiu a fost 51 de ani. Diametrul mediu al colecţiilor intraabdominale a fost de 109 mm (34-250 mm), acesta corelându-se cu metoda de tratament aleasă (p<0.005): drenaj ghidat eco-endoscopic, drenaj percutan, intervenţie chirurgicală, ca monoterapie sau combinaţii între acestea. Mortalitatea peri-procedurală a fost de 9,3%, asociată în principal cu severitatea patologiei ori cu asocierea chirurgiei în tratament. Concluzii: În conluzie, prin studiul efectuat putem afirma că ecoendoscopia poate fi metoda de primă intenţie în a drena colecţiile intra abdominale perigastrice, pentru că reprezintă o metodă sigură şi eficientă, cu un success tehnic de 100% în timp ce succesul clinic de peste 80% asigură o mai bună calitate a vieţii. Pentru colecţiile ce au un diametru mai mare de 127 mm, ne putem aştepta totuşi la necesitate unui tratament combinat, ecoendoscopic şi chirurgical. Cuvinte cheie: colecţii intraabdominale, drenaj transgastric, percutan, chirurgie, ecoendoscopie

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“…Usually, the right time to perform endoscopic intervention is after 4 weeks as it allowed better encapsulation. Recent systematic review, comparing percutaneous, surgical, and endoscopic methods in managing PPC, shows that endoscopic management using EUS reduced the length of hospital admission time, cost, and improved patient's quality of life [21,22].…”

Section: Endoscopic Management Of Pancreatic Fluid Collection: Histormentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collection in Acute Pancreatitis

Lesmana¹,

Lesmana²,

Ho³

2019

Pancreatitis

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Acute pancreatitis is an acute clinical condition where it can be manifested as mild disease or serious and life-threatening condition. There are several factors that may be responsible for this condition, such as genetic, gallstone disease, alcohol consumption, pancreatic trauma, medication, hypertriglyceridemia, autoimmune disease, and surgery. The most common manifestation of pancreatic parenchymal injury is pancreatic pseudocyst (PPC) formation, where peripancreatic fluid collection (PFCs) usually precedes this condition. Even though most of the pseudocyst can be managed conservatively, however in conditions such as infected pseudocyst or possible wall of necrosis (WON), there should be an early intervention management. Clinical evaluation and imaging studies have to be done in the beginning. Computed tomography (CT) scan or magnetic resonance imaging (MRI) are the main imaging techniques used to evaluate the characteristic of the cyst, the size, surrounding vascularity, and to assess the pancreatic duct itself with possible of fistula formation. Clinical conditions that are usually considered for early intervention management are symptomatic pseudocyst, large size of pseudocyst, presence of gastric outlet obstruction, or biliary obstruction. PFC should be evaluated as it has been classified based on type of pancreatitis, time frame, well-defined wall, and debris contained inside the cyst. Endoscopic management has replaced percutaneous and surgical approach in most of PFC cases. Nowadays, endoscopic ultrasound (EUS) has been widely used as the first-line tool for PFC drainage procedure. Pancreatic pseudocyst stenting is the most common procedure in most of the centers in the world. However, the cost, availability, and expertise are needed to be considered in clinical practice.

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Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

Cited by 46 publications

References 55 publications

Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

Prevalence and outcomes of cystic lesions of the transplant pancreas: The University of Wisconsin Experience

EUS-Guided Transgastric Drainage of Intraabdominal Fluid Collections

Endoscopic Management of Pancreatic Fluid Collection in Acute Pancreatitis

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