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World J Gastroenterol. Nov 7, 2015; 21(41): 11842-11853
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11842
Endosonography guided management of pancreatic fluid collections
Andreas S Vilmann, John Menachery, Shou-Jiang Tang, Indu Srinivasan, Peter Vilmann
Andreas S Vilmann, Peter Vilmann, Department of Surgical Gastroenterology, Copenhagen University Hospital Herlev, 2730 Herlev, Denmark
John Menachery, Department of Gastroenterology, Rajagiri Hospital Aluva, Kerala 683112, India
Shou-Jiang Tang, Indu Srinivasan, Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: All authors were involved in the design and conduct of this work; Menachery J and Tang SJ performed the research; Vilmann AS and Menachery J drafted the article; all authors contributed equally to revising the manuscript and approving the final version.
Conflict-of-interest statement: Vilmann AS, Menarchy J, Srinivasan I and Tang SJ have no potential conflicts of interest. Vilmann P reported a conflict as a consultant for MediGlobe, GmbH, Grassau, Germany.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreas S Vilmann, MD, Department of Surgical Gastroenterology, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark. andreas.vilmann@gmail.com
Telephone: +45-51-365185
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: June 24, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: November 7, 2015
Processing time: 189 Days and 10.7 Hours
Abstract

The revised Atlanta classification of acute pancreatitis was adopted by international consensus, and is based on actual local and systemic determinants of disease severity. The local determinant is pancreatic necrosis (sterile or infected), and the systemic determinant is organ failure. Local complications of pancreatitis can include acute peri-pancreatic fluid collection, acute necrotic collection, pseudocyst formation, and walled-off necrosis. Interventional endoscopic ultrasound (EUS) has been increasing utilized in managing these local complications. After performing a PubMed search, the authors manually applied pre-defined inclusion criteria or a filter to identify publications relevant to EUS and pancreatic collections (PFCs). The authors then reviewed the utility, efficacy, and risks associated with using therapeutic EUS and involved EUS devices in treating PFCs. Due to the development and regulatory approval of improved and novel endoscopic devices specifically designed for transmural drainage of fluid and necrotic debris (access and patency devices), the authors predict continuing evolution in the management of PFCs. We believe that EUS will become an indispensable part of procedures used to diagnose PFCs and perform image-guided interventions. After draining a PFC, the amount of tissue necrosis is the most important predictor of a successful outcome. Hence, it seems logical to classify these collections based on their percentage of necrotic component or debris present when viewed by imaging methods or EUS. Finally, the authors propose an algorithm for managing fluid collections based on their size, location, associated symptoms, internal echogenic patterns, and content.

Keywords: Endoscopic ultrasound; Drainage; Pancreatic fluid collection; Pseudocyst; Patency device; Abscess; Walled of necrosis; Pancreas

Core tip: The revised Atlanta classification of acute pancreatitis was approved by international consensus, and is based on actual local and systemic determinants of disease severity. Local complications of pancreatitis can include acute peri-pancreatic fluid collection, acute necrotic collection, pseudocyst formation, and walled-off necrosis. Interventional endoscopic ultrasound (EUS) has been increasingly utilized in managing pancreatitis. This review describes the utility, efficacy, and risks associated with using therapeutic EUS and involved EUS devices to manage acute pancreatitis. The authors propose an algorithm for use in managing pancreatic fluid collections based on their size, location, associated symptoms, internal echogenic patterns, and content.