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World J Gastroenterol. Nov 21, 2014; 20(43): 16191-16196
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16191
Endoscopic ultrasonography-guided endoscopic treatment of pancreatic pseudocysts and walled-off necrosis: New technical developments
Barbara Braden, Christoph F Dietrich
Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Oxford OX3 9DU, United Kingdom
Christoph F Dietrich, Med. Klinik 2, Caritas Hospital, Uhlandstr. 7, 97980 Bad Mergentheim, Germany
Author contributions: Braden B wrote the paper; Dietrich CF critically revised the manuscript.
Correspondence to: Barbara Braden, Professor, Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Headley Way, Oxford OX3 9DU, United Kingdom.
Telephone: +44-18-65228760 Fax: +44-18-65228763
Received: April 3, 2014
Revised: June 18, 2014
Accepted: July 15, 2014
Published online: November 21, 2014

In the last decades, the treatment of pancreatic pseudocysts and necrosis occurring in the clinical context of acute and chronic pancreatitis has shifted towards minimally invasive endoscopic interventions. Surgical procedures can be avoided in many cases by using endoscopically placed, Endoscopic ultrasonography-guided techniques and drainages. Endoscopic ultrasound enables the placement of transmural plastic and metal stents or nasocystic tubes for the drainage of peripancreatic fluid collections. The development of self-expanding metal stents and exchange free delivering systems have simplified the drainage of pancreatic fluid collections. This review will discuss available therapeutic techniques and new developments.

Keywords: Pancreatic pseudocyst, Walled-off necrosis, Endoscopic ultrasonography-guided drainage, Self-expanding metal stent, Acute pancreatitis

Core tip: Endoscopic ultrasonography (EUS)-guided drainage of pancreatic pseudocysts and walled-off necrosis has become an established less invasive management of these difficult to treat complications of acute and chronic pancreatitis. New developments such as forward-viewing echoscopes and exchange-free delivery systems for the insertion of stents and drainages have simplified the technically challenging procedure. Specially designed self-expanding metal stents aim on improved drainage of the cyst content. This article reviews new EUS-guided techniques and their indications.