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Endoscopic ultrasonography‐guided drainage of pancreatic fluid collections
Author(s) -
Ang Tiing Leong,
Teoh Anthony Y.B.
Publication year - 2017
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12797
Subject(s) - medicine , drainage , endoscopic ultrasound , percutaneous , endoscopic ultrasonography , context (archaeology) , pancreatic pseudocyst , stent , radiology , biliary drainage , surgery , endoscopy , pancreatitis , ecology , paleontology , biology
Endoscopic ultrasound ( EUS )‐guided drainage is now firmly established as the best option for drainage of walled‐off pancreatic fluid collections ( PFC ). It has high clinical efficacy, similar to surgical and percutaneous approaches, but with lower morbidity and costs. It is superior to non‐ EUS ‐guided approaches because even collections without endoluminal bulging can be successfully drained. Transmural drainage alone is sufficient for pseudocysts, but in the context of walled‐off pancreatic necrosis ( WON ), adjunctive direct endoscopic necrosectomy ( DEN ) may be required. Traditionally, double pigtail plastic stents ( PS ) were used for transmural drainage, but, recently, fully covered self‐expandable metallic stents ( FCSEMS ) customized for PFC drainage have become available and are increasingly used, especially in the management of WON , because the larger‐diameter stent facilitates drainage and insertion of an endoscope into the WON cavity for DEN . The present review will discuss the evidence for EUS ‐guided drainage and DEN , the technical problems involved, and the roles of PS and FCSEMS in PFC drainage.