Year 2020 / Volume 112 / Number 6
Review
Management of pancreatic collections: an update

483-490

DOI: 10.17235/reed.2020.6814/2019

Ana García García de Paredes, Sergio López-Durán, José Ramón Foruny Olcina, Agustín Albillos, Enrique Vázquez-Sequeiros,

Abstract
Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.
Share Button
New comment
Comments

15/12/2020 0:27:09
Muy interesante actualización


09/06/2020 18:43:26
Buenas tardes desde Mèrida-Venezuela, les escribe el Dr Gerardo A. Casanova A, mèdico gastroenteròlogo, excelente artìculo, mis felcitaciones a los autoras/es.


References
1. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11.
2. Dhaka N, Samanta J, Kochhar S, et al. Pancreatic fluid collections: What is the ideal imaging technique? World J Gastroenterol 2015;21:13403-10.
3. Kamal A, Singh VK, Akshintala VS, et al. CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012. Abdom Imaging 2015;40:1608-16.
4. Ortiz Moyano C, Martin Guerrero J, Rojas Feria M. A giant abdominal collection: when things are not what they seem. Rev Esp Enferm Dig 2018;110:832-33.
5. Committee ASoP, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc 2016;84:1-9.
6. Cui ML Kim KH, Kim HG, et al. Incidence, risk factors and clinical course of pancreatic fuid collections in acute pancreatitis. Dig Dis Sci 2014;59:1055-62.
7. Sarathi P, Das K, Bhattacharyya A, et al. Natural resolution or intervention for fuid collections in acute severe pancreatitis. Br J Surg 2014;101:1721-28.
8. Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018;50:524-46.
9. Baron TH, DiMaio CJ, Wang AY, et al. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology 2019 [Epub ahead of print].
10. Yang CJ, Chen J, Phillips AR, et al. Predictors of severe and critical acute pancreatitis: a systematic review. Dig Liver Dis 2014;46:446-51.
11. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141:1254-63.
12. Trikudanathan G, Tawfik P, Amateau SK, et al. Early (4 Weeks) Versus Standard (>/= 4 Weeks) Endoscopically Centered Step-Up Interventions for Necrotizing Pancreatitis. Am J Gastroenterol 2018;113:1550-58.
13. VaradarajuluS B, PhadnisMA, ChristeinJD, et al. Endoscopic transmural drainage of peripancreatic fuid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg 2011;15:2080-88.
14. Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition. Dig Surg 2006;23:336-44.
15. Hollemans RA, Hallensleben NDL, Mager DJ, et al. Pancreatic exocrine insufficiency following acute pancreatitis: Systematic review and study level meta-analysis. Pancreatology 2018;18:253-62.
16. Powers PC, Siddiqui A, Sharaiha RZ, et al. Discontinuation of proton pump inhibitor use reduces the number of endoscopic procedures required for resolution of walled-off pancreatic necrosis. Endosc Ultrasound 2019;8:194-98.
17. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491-502.
18. van Baal MC, van Santvoort HC, Bollen TL, et al. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011;98:18-27.
19. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018;391:51-58.
20. Ross AS, Irani S, Gan SI, et al. Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes. Gastrointest Endosc 2014;79:929-35.
21. Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis. Gastroenterology 2019;156:1016-26.
22. Keane MG, Sze SF, Cieplik N, et al. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2015;30.
23. Khan MA, Hammad T, Khan Z, et al. Endoscopic versus percutaneous management for symptomatic pancreatic fluid collections: a systematic review and meta-analysis. Endosc Int Open 2018;6:E474-83.
24. Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013;145:583-90.
25. Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic Transgastric vs Surgical Necrosectomy for Infected Necrotizing Pancreatitis. JAMA 2012;307:1053-61.
26. Bang JY, Arnoletti JP, Holt BA, et al. An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology 2019;156:1027-40.
27. Sahel J, Bastid C, Pellat B, et al. Endoscopic cystoduodenostomy for cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 1987;2:447-53.
28. Howell DA, Shah RJ. Mamagement of pancreatic pseudocysts and walled-off pancreatic necrosis (2018). UpToDate. Retrieved November 1, 2019.
29. Bang JY, Navaneethan U, Hasan MK, et al. Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial. Gut 2019;68:1200-09.
30. Committee ASoP, Khashab MA, Chithadi KV, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015;81:81-9.
31. Yang D, Amin S, Gonzalez S, et al. Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study. Gastrointest Endosc 2016;83:720-9.
32. Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointesitn Endosc 2008;68:1102-11.
33. Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009;41:842-8.
34. Vazquez-Sequeiros E, Baron TH, Pérez-Miranda M, et al. Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry. Gastrointesitn Endosc 2016;84:450-57.
35. Lee BU, Song TJ, Lee SS, et al. Newly designed, fully covered metal stents for endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collections: a prospective randomized study. Endoscopy 2014;46:1078-84.
36. Bang JY HR, Bartolucci, Varadarjulu S. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: A systematic review. Dig Endosc 2015;27:486-98.
37. Bazerbachi F, Sawas T, Vargas EJ, et al. Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: a systematic review and meta-analysis. Gastrointest Endosc 2018;87:30-42 e15.
38. van der Wiel SE, Poley JW, Grubben M, et al. The EndoRotor, a novel tool for the endoscopic management of pancreatic necrosis. Endoscopy 2018;50:E240-41.
39. van Brunschot S, Fockens P, Bakker OJ, et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. . Surg Endosc 2014;28:1425-38.
40. Rana SS, Bhasin DK, Sharma RK, et al. Do the morphological features of walled off pancreatic necrosis on endoscopic ultrasound determine the outcome of endoscopic transmural drainage? Endosc Ultrasound 2014;3:118-22.
41. Gurusamy KS, Pallari E, Hawkins N, et al. Management strategies for pancreatic pseudocysts. Cochrane Database Syst Rev 2016;4:CD011392.
42. Varadarajulu S, Phadnis MA, Christein JD, et al. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis. Gastrointest Endosc 2011;74:74-80.
43. Werge M, Novovic S, Roug S, et al. Evaluation of local instillation of antibiotics in infected walled-off pancreatic necrosis. Pancreatology 2018;18:642-46.
44. Siddiqui AA, Easler J, Strongin A, et al. Hydrogen peroxide-assisted endoscopic necrosectomy for walled-off pancreatic necrosis: a dual center pilot experience. Dig Dis Sci 2014;59:687-90.
45. Fugazza A, Sethi A, Trindade AJ, et al. International multicenter comprehensive analysis of adverse events associated with lumen-apposing metal stent placement for pancreatic fluid collection drainage. Gastrointest Endosc 2019 [Epub ahead of print].
46. Puga M, Consiglieri CF, Busquets J, et al. Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study. Endoscopy 2018;50:1022-26.
DOI: 10.3748/wjg.v21.i48.13403
DOI: 10.4103/2303-9027.131039
Related articles

Letter

Spontaneous cystogastric fistula: an accidental discovery

DOI: 10.17235/reed.2023.9912/2023

Letter

Acute cholecystitis treated by direct visualization endoscopy

DOI: 10.17235/reed.2023.9432/2022

Letter

Spontaneous drainage of a pancreatic pseudocyst into the stomach

DOI: 10.17235/reed.2022.8999/2022

Letter

Lumen-apposing metal stent deployment failure

DOI: 10.17235/reed.2020.7060/2020

Editorial

Guessing the future of endoscopic drainage of walled-off necrosis

DOI: 10.17235/reed.2020.7252/2020

Letter

A giant liver abscess due to Fasciola hepatica infection

DOI: 10.17235/reed.2019.6136/2018

Digestive Diseases Image

Cumbersome removal of an endoscopic nasobiliary drainage tube

DOI: 10.17235/reed.2019.5962/2018

Digestive Diseases Image

A rare case of acute obstructive suppurative pancreatic ductitis associated with ERCP

DOI: 10.17235/reed.2018.5756/2018

Letter

A giant abdominal collection: when things are not what they seem

DOI: 10.17235/reed.2018.5642/2018

Letter to the Editor

Late migration of a metal stent after EUS-drainage of a pancreatic pseudocyst abscess

DOI: 10.17235/reed.2018.5411/2017

Case Report

Pseudoaneurysm associated with complicated pancreatic pseudocysts

DOI: 10.17235/reed.2016.3855/2015

Citation tools
García García de Paredes A, López-Durán S, Foruny Olcina J, Albillos A, Vázquez-Sequeiros E. Management of pancreatic collections: an update. 6814/2019


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2510 visits.
This article has been downloaded 1833 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 12/12/2019

Accepted: 19/01/2020

Online First: 26/05/2020

Published: 08/06/2020

Article revision time: 23 days

Article Online First time: 166 days

Article editing time: 179 days


Share
This article has been rated by 3 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology