Pancreatic fluid collection drainage by endoscopic ultrasound: an update

Abstract

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

Keywords: Endosonography; Nonbulging pancreatic fluid collections; Pancreatic fluid collections; Pancreatic pseudocyst.

Fig. 1

Endoscopic ultrasound view of the needle puncture.

Fig. 2

Fluoroscopic view of guidewire placed through the stomach wall.

Fig. 3

Fluoroscopic view of guidewire within the pancreatic fluid collection.

Fig. 4

Fluoroscopic view of balloon dilation of the tract.

Fig. 5

Endoscopic view of balloon dilation of the tract.

Fig. 6

Endoscopic view of deployed metal stent.

Fig. 7

Fluoroscopic view of the pigtails placed within the metal stent.