Proença IM, dos Santos MEL, de Moura DTH, Ribeiro IB, Matuguma SE, Cheng S, McCarty TR, do Monte Junior ES, Sakai P, de Moura EGH. Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification. World J Gastroenterol 2020; 26(45): 7104-7117 [PMID: 33362371 DOI: 10.3748/wjg.v26.i45.7104]
Corresponding Author of This Article
Igor Braga Ribeiro, MD, Research Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 255, Instituto Central, Prédio dos Ambulatórios, Pinheiros, São Paulo 05403000, Brazil. igorbraga1@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Gastroenterol. Dec 7, 2020; 26(45): 7104-7117 Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7104
Role of pancreatography in the endoscopic management of encapsulated pancreatic collections – review and new proposed classification
Igor Mendonça Proença, Marcos Eduardo Lera dos Santos, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sergio Eiji Matuguma, Spencer Cheng, Thomas R McCarty, Epifanio Silvino do Monte Junior, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura
Igor Mendonça Proença, Marcos Eduardo Lera dos Santos, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sergio Eiji Matuguma, Spencer Cheng, Epifanio Silvino do Monte Junior, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo, São Paulo 05403000, Brazil
Diogo Turiani Hourneaux de Moura, Thomas R McCarty, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
Author contributions: Proença IM, Dos Santos MEL, de Moura DTH, Ribeiro IB, Matuguma SE, Sakai P and de Moura EGH contributed to acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Cheng S, McCarty TR and do Monte Júnior ES contributed to revising, editing and drafting article, final approval.
Conflict-of-interest statement: Dr. Moura reports personal fees from Boston Scientific, personal fees from Olympus, outside the submitted work.
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/
Corresponding author: Igor Braga Ribeiro, MD, Research Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 255, Instituto Central, Prédio dos Ambulatórios, Pinheiros, São Paulo 05403000, Brazil. igorbraga1@gmail.com
Received: October 4, 2020 Peer-review started: October 4, 2020 First decision: October 27, 2020 Revised: November 8, 2020 Accepted: November 21, 2020 Article in press: November 21, 2020 Published online: December 7, 2020 Processing time: 60 Days and 7 Hours
Abstract
Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated. Within the last decade, endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage. Proper understanding of anatomic landmarks, including assessment of the main pancreatic duct and any associated lesions – such as disruptions and strictures – are key to achieving clinical success, reducing the need for reintervention or recurrence, especially in cases with suspected disconnected pancreatic duct syndrome. Additionally, proper review of imaging and anatomic landmarks, including collection location, are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents. Pancreatography to adequately assess the main pancreatic duct may be performed by two methods: Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde cholangiopan-creatography. Despite the critical need to understand anatomy via pancrea-tography and assess the main pancreatic duct, a standardized approach or uniform assessment strategy has not been described in the literature. Therefore, the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.
Core Tip: This review investigates the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and proposes a new simplified classification system for endoscopic pancreatography findings as well as endoscopic management.
