Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification

Figure 1 Nordback et al[7] (1988) classification. Type I: Normal main pancreatic duct (MPD) contrasting (type IA) or not (type IB) the collection; Type II: MPD opens to the collection; Type III: MPD with stenosis contrasting (type IIIA) or not (type IIIB) the collection.

Figure 2 Nealon et al[37] (2009) classification. Type I: Normal main pancreatic duct (MPD); Type II: MPD stricture; Type III: MPD occlusion; Type IV: Chronic pancreatitis. All types are subdivided according if they have communication (subtype A) or not (subtype B) with the collection.

Figure 3 Mutignani et al[35] (2017) classification. Type I: Leakages from small side brunches in the pancreatic head (IH), body (IB) or tail (IT); Type II: Leak in the main pancreatic duct that may have an open (IIO) or close (IIC) proximal stump; Type III: Leaks after pancreatectomy that may be after proximal pancreas (IIIP) or distal pancreas (IIID) resection.

Figure 4 Dhir et al[23] (2018) classification. Type I: Disconnection in the neck/body region, with a ductal leak at the proximal end; Type II: Disconnected duct with a Walled-off Necrosis distal to the disconnection – not possible to ascertain ductal communication with collection; Type III: Ductal leak without disconnection; Type IV: Shows a noncommunicating Walled-off Necrosis, with no disconnection.

Figure 5 Lera-Proença (2020) new proposed classification. Type I: Normal main pancreatic duct; Type II: Stricture; Type III: Partial disruption – main pancreatic duct contrasts beyond disruption; Type IV: Complete disruption - main pancreatic duct does not contrast beyond disruption. IV-A: with contrast extravasation or IV-B: without contrast extravasation and cut-off.

Figure 6 Endoscopic pancreatography classified by Lera-Proença classification. Endoscopic pancreatography findings, A: Normal pancreatography (type I); B: Stricture (type II); C: Partial disruption (type III); D: Complete disruption with contrast extravasation (type IV-A); E: Complete disruption without contrast extravasation and cut-off (Type IV-B); and F: Stricture and complete disruption with contrast extravasation (Type II + IV-A).