Endoscopic ultrasound guided drainage of pancreatic fluid collections: Assessment of the procedure, technical details and review of the literature

Abstract

Endoscopic ultrasound (EUS) guided drainage of pancreatic fluid collections (PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.

Keywords: Acute pancreatitis; Endoscopic ultrasound-guided drainage; Pancreatic fluid collections.

Figure 1

Endoscopic view of intragastric bulge due to pancreatic fluid collections (A), endosonographic view of pancreatic fluid collections (B), Dilation of fistula with Controlled radial expansion (CRE^TM) catheter balloon (C), Placement of double pigtail plastic stents through the fistula (D).

Figure 2

Placement of double pigtail plastic stent and nasocystic drain (A), computed tomography view of pancreatic fluid collections after insertion of stent and nasocystic drain (B), endosonographic view of pancreatic fluid collections before drainage (C), computed tomography view of pancreatic fluid collections before drainage (D), Placement of NAGI stent into pancreatic fluid collections (E), computed tomography view after placement of NAGI stent (F).