Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections

Abstract

Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.

Keywords: Complications; Drainage; Endoscopy; Pancreatitis; Pseudocyst.

Fig. 1.

Search flow chart.

Fig. 2.

Acute interstitial edematous pancreatitis with acute peripancreatic fluid collections (APFC) in the left anterior pararenal space.

Fig. 3.

A pseudocyst in the lesser sac.

Fig. 4.

Acute necrotic collection with acute necrotizing pancreatitis involving the body and tail of the pancreas.

Fig. 5.

Walled of necrosis. A large liquefied collection with air bubbles in the bed of the pancreas.