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Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis.
Curr Treat Options Gastroenterol 2017; 15(4):576-586CT

Abstract

OPINION STATEMENT

Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. asiddiqu2004@gmail.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29103188

Citation

Shah, Apeksha, et al. "Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis." Current Treatment Options in Gastroenterology, vol. 15, no. 4, 2017, pp. 576-586.
Shah A, Denicola R, Edirisuriya C, et al. Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis. Curr Treat Options Gastroenterol. 2017;15(4):576-586.
Shah, A., Denicola, R., Edirisuriya, C., & Siddiqui, A. A. (2017). Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis. Current Treatment Options in Gastroenterology, 15(4), pp. 576-586. doi:10.1007/s11938-017-0161-z.
Shah A, et al. Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis. Curr Treat Options Gastroenterol. 2017;15(4):576-586. PubMed PMID: 29103188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of Inflammatory Fluid Collections and Walled-Off Pancreatic Necrosis. AU - Shah,Apeksha, AU - Denicola,Richard, AU - Edirisuriya,Cynthia, AU - Siddiqui,Ali A, PY - 2017/11/6/pubmed PY - 2017/11/6/medline PY - 2017/11/6/entrez KW - Endoscopy KW - Pancreatic fluid collections KW - Pancreatic pseudocyst KW - Pancreatic walled-off necrosis KW - Stents SP - 576 EP - 586 JF - Current treatment options in gastroenterology JO - Curr Treat Options Gastroenterol VL - 15 IS - 4 N2 - OPINION STATEMENT: Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting. SN - 1092-8472 UR - https://www.unboundmedicine.com/medline/citation/29103188/Management_of_Inflammatory_Fluid_Collections_and_Walled_Off_Pancreatic_Necrosis_ L2 - https://dx.doi.org/10.1007/s11938-017-0161-z DB - PRIME DP - Unbound Medicine ER -