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Review
. 2022 Apr 25:7:17.
doi: 10.21037/tgh-2020-06. eCollection 2022.

Management of pancreatic fluid collections

Dimpal Bhakta  1 , Rabia de Latour  1 , Lauren Khanna  1
Affiliations
Review

Management of pancreatic fluid collections

Dimpal Bhakta et al. Transl Gastroenterol Hepatol. .

Abstract

Pancreatic fluid collections often develop as a complication of acute pancreatitis but can be seen in a variety of conditions including chronic pancreatitis, trauma, malignancy or post-operatively. It is important to classify a pancreatic fluid collection in order to optimize treatment strategies and management. Most interventions are targeted towards the management of delayed complications of pancreatitis, including pancreatic pseudocysts and walled-off necrosis (WON), which often develop days to weeks after the initial episode of pancreatitis. Surgical, percutaneous, and endoscopic interventions are all possible methods for treatment of pancreatic fluid collections, however endoscopic drainage with endoscopic ultrasound has become first-line. Advances within endoscopic drainage strategies have also led to innovative changes in the specific stents used for treatment, with possible options including double pigtail plastic stents, fully covered self-expanding metal stents and lumen-apposing metal stents (LAMS).

Keywords: Drainage; pancreatic fluid collection; pancreatitis; stents; walled-off necrosis (WON).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-2020-06/coif). The series “Innovation in Endoscopy” was commissioned by the editorial office without any funding or sponsorship. All authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Acute interstitial pancreatitis.
Figure 2
Figure 2
Acute peripancreatic fluid collection.
Figure 3
Figure 3
Pancreatic pseudocyst.
Figure 4
Figure 4
Acute pancreatic necrosis.
Figure 5
Figure 5
Acute necrotic collection.
Figure 6
Figure 6
Walled off necrosis.
Figure 7
Figure 7
EUS view: PFC. EUS, endoscopic ultrasound; PFC, pancreatic fluid collection.
Figure 8
Figure 8
EUS view: insertion of 19-gauge needle into PFC. EUS, endoscopic ultrasound; PFC, pancreatic fluid collection.
Figure 9
Figure 9
Fluoroscopy view: contrast injection into cavity of PFC. PFC, pancreatic fluid collection.
Figure 10
Figure 10
Fluoroscopy view: balloon dilation of gastric wall tract into PFC. PFC, pancreatic fluid collection.
Figure 11
Figure 11
Endoscopy view: pus drainage after tract dilation.
Figure 12
Figure 12
Fluoroscopy view: plastic stent advanced over wire coiled in PFC. PFC, pancreatic fluid collection.
Figure 13
Figure 13
Endoscopy view: two double pigtail plastic stents.
Figure 14
Figure 14
EUS view: PFC. EUS, endoscopic ultrasound; PFC, pancreatic fluid collection.
Figure 15
Figure 15
EUS view: PFC puncture. EUS, endoscopic ultrasound; PFC, pancreatic fluid collection.
Figure 16
Figure 16
EUS view: deployment of LAMS flange within PFC. EUS, endoscopic ultrasound; LAMS, lumen-apposing metal stents; PFC, pancreatic fluid collection.
Figure 17
Figure 17
Endoscopic view: fluid emanating from cyst after deployment of LAMS flange in gastric lumen. LAMS, lumen-apposing metal stents.
Figure 18
Figure 18
Endoscopic view: two double pigtail plastic stents through LAMS. LAMS, lumen-apposing metal stents.
Figure 19
Figure 19
Endoscopic view: necrotic cavity before diluted hydrogen peroxide lavage.
Figure 20
Figure 20
Endoscopic view: necrotic cavity after diluted hydrogen peroxide lavage.
Figure 21
Figure 21
Flow diagram for management of pancreatic fluid collections. DPS, double pigtail plastic stent; LAMS, lumen apposing metal stent; WON, walled-off necrosis; DEN, direct endoscopic necrosectomy; DMD, dual modality drainage; MTGT, multiple transluminal gateway technique; DPDS, disconnected pancreatic duct syndrome; ERCP, endoscopic retrograde cholangiopancreatography.
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