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EUS‐GUIDED DRAINAGE OF PANCREATIC PSEUDOCYSTS, ABSCESSES AND INFECTED NECROSIS
Author(s) -
Seewald Stefan,
Ang Tiing Leong,
Teng Karl C Yu Kim,
Soehendra Nib
Publication year - 2009
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/j.1443-1661.2009.00860.x
Subject(s) - medicine , drainage , endoscopic ultrasound , pancreatic pseudocyst , percutaneous , surgery , perforation , radiology , abscess , context (archaeology) , pancreatitis , ecology , paleontology , materials science , metallurgy , punching , biology
Endoscopic ultrasound (EUS)‐guided drainage has emerged as the leading treatment modality for symptomatic pancreatic fluid collections. Endoscopic ultrasound‐guided endoscopic drainage is less invasive than surgery and avoids local complications related to percutaneous drainage. In addition, unlike non‐EUS guided endoscopic drainage, EUS‐guided drainage is able to drain non‐bulging fluid collections and may reduce the risk of procedure‐related bleeding. Excellent treatment success rates exceeding 90% have been reported for pancreatic pseudocysts and abscesses. In the context of infected pancreatic necrosis, adjunctive endoscopic necrosectomy is required for effective treatment. With such an aggressive approach, the treatment success rate may reach 81%–92%. The potential complications of concern for EUS‐guided drainage are severe bleeding and perforation. To minimize risk, only fluid collections with a mature wall and within 1 cm of the gastrointestinal lumen should undergo endoscopic drainage. Any coagulopathy, if present, should be corrected. Patients with pseudocysts undergoing drainage should also receive prophylactic antibiotics in order to prevent secondary infection of a sterile collection.