Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2660
Peer-review started: January 4, 2017
First decision: February 10, 2017
Revised: February 27, 2017
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: April 21, 2017
The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.
Core tip: The management of pancreatic fluid collections has revolutionised over last several decades. New devices and techniques have evolved which have largely obviated the need for surgery in these patients. The differentiation of nature of fluid collections into pseudocyst and walled off necrosis has enabled the endoscopist to plan management strategies. With the introduction of dedicated metal stents, the task of endoscopic necrosectomy has become easier. However, all patients with pancreatic fluid collections cannot be managed in the same way. Therefore, the management of pancreatic fluid collections (PFC) requires multidisciplinary and individualised approach. In this review, we describe the recent advances and controversial issues in the endoscopic management of PFC.