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Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm
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Ming Ming Xu, Iman Andalib, Aleksey Novikov, Enad Dawod, Moamen Gabr, Monica Gaidhane, Amy Tyberg, Michel Kahaleh
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Clin Endosc 2020;53(3):355-360. Published online December 3, 2019
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DOI: https://doi.org/10.5946/ce.2019.113
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 Abstract
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- Background
/Aims: Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.
Methods
Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.
Results
A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).
Conclusions
A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.
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Citations
Citations to this article as recorded by  - Novel classification system for walled-off necrosis: a step toward standardized nomenclature and risk-stratification framework
Serge Baroud, Vinay Chandrasekhara, Andrew C. Storm, Ryan J. Law, Eric J. Vargas, Michael J. Levy, Tala Mahmoud, Fateh Bazerbachi, Aliana Bofill-Garcia, Rabih Ghazi, Daniel B. Maselli, John A. Martin, Santhi Swaroop Vege, Naoki Takahashi, Bret T. Petersen
Gastrointestinal Endoscopy.2023; 97(2): 300. CrossRef - Endoscopic versus percutaneous drainage for pancreatic fluid collection after pancreatic surgery: An up-to-date meta-analysis and systematic review
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Asian Journal of Surgery.2022; 45(8): 1519. CrossRef - Transluminal and retroperitoneal minimally invasive necrosectomy in acute pancreatitis
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A.V. Fedorov, V.N. Ektov, M.A. Khodorkovsky
Khirurgiya. Zhurnal im. N.I. Pirogova.2021; (9): 85. CrossRef - Hydrogen peroxide assisted endoscopic necrosectomy for walled-off pancreatic necrosis: A systematic review and meta-analysis
Rajat Garg, Shradha Gupta, Amandeep Singh, Marian T. Simonson, Tarun Rustagi, Prabhleen Chahal
Pancreatology.2021; 21(8): 1540. CrossRef - The Diagnostic Dilemma of Malignant Biliary Strictures
Robert Dorrell, Swati Pawa, Yi Zhou, Neeraj Lalwani, Rishi Pawa
Diagnostics.2020; 10(5): 337. CrossRef - Importance of Pancreatic Duct Stenting and Enteral Feeding in Treatment Algorithm of Pancreatic Fluid Collections
Seong-Hun Kim, Eun Ji Shin
Clinical Endoscopy.2020; 53(3): 253. CrossRef - Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification
Igor Mendonça Proença, Marcos Eduardo Lera dos Santos, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sergio Eiji Matuguma, Spencer Cheng, Thomas R McCarty, Epifanio Silvino do Monte Junior, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura
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