Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.381
Peer-review started: November 2, 2014
First decision: December 12, 2014
Revised: December 30, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 16, 2015
Treatment of pancreatic collections has experienced great progress in recent years with the emergence of alternative minimally invasive techniques comparing to the classic surgical treatment. Such techniques have been shown to improve outcomes of morbidity vs surgical treatment. The recent emergence of endoscopic drainage is noteworthy. The advent of endoscopic ultrasonography has been crucial for treatment of these specific lesions. They can be characterized, their relationships with neighboring structures can be evaluated and the drainage guided by this technique has been clearly improved compared with the conventional endoscopic drainage. Computed tomography is the technique of choice to characterize the recently published new classification of pancreatic collections. For this reason, the radiologist’s role establishing and classifying in a rigorously manner the collections according to the new nomenclature is essential to making therapeutic decisions. Ideal scenario for comprehensive treatment of these collections would be those centers with endoscopic ultrasound and interventional radiology expertise together with hepatobiliopancreatic surgery. This review describes the different types of pancreatic collections: acute peripancreatic fluid collection, pancreatic pseudocysts, acute necrotic collection and walled-off necrosis; the indications and the contraindications for endoscopic drainage, the drainage technique and their outcomes. The integrated management of pancreatic collections according to their type and evolution time is discussed.
Core tip: The interventional endoscopic ultrasonography (EUS) development has become in recent years as the first therapeutic alternative for the management of pancreatic collections. The great advantage of EUS is the possibility to in see in real-time image with ultrasound guidance all the material previously introduced into the working channel. The new classification of Atlanta 2012 defines two different evolved pancreatic collections (≥ 4 wk) such as pseudocysts and necrotic encapsulated collections. If both types of collections are symptomatic, they would be subsidiaries of treatment. Given their morphological differences, the technique is similar but the stents used and the results generated differ.