Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomat...
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| Format: | Article |
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MDPI AG
2024-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/2/333 |
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| author | Cecilia Binda Stefano Fabbri Barbara Perini Martina Boschetti Chiara Coluccio Paolo Giuffrida Giulia Gibiino Chiara Petraroli Carlo Fabbri |
| author_facet | Cecilia Binda Stefano Fabbri Barbara Perini Martina Boschetti Chiara Coluccio Paolo Giuffrida Giulia Gibiino Chiara Petraroli Carlo Fabbri |
| author_sort | Cecilia Binda |
| collection | DOAJ |
| description | Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs. |
| first_indexed | 2024-03-07T22:22:07Z |
| format | Article |
| id | doaj.art-ba8f416947aa4f73ad468f88288f27db |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-07T22:22:07Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-ba8f416947aa4f73ad468f88288f27db2024-02-23T15:26:47ZengMDPI AGMedicina1010-660X1648-91442024-02-0160233310.3390/medicina60020333Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already SolvedCecilia Binda0Stefano Fabbri1Barbara Perini2Martina Boschetti3Chiara Coluccio4Paolo Giuffrida5Giulia Gibiino6Chiara Petraroli7Carlo Fabbri8Gastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5, 45100 Rovigo, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyGastroenterology and Digestive Endoscopy Unit, AUSL Romagna, Forlì-Cesena Hospitals, 47121 Forlì, ItalyPancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs.https://www.mdpi.com/1648-9144/60/2/333walled-off pancreatic necrosispancreatic fluid collectionsEUS-guided drainagestep-up approachLAMSdouble pigtail plastic stents |
| spellingShingle | Cecilia Binda Stefano Fabbri Barbara Perini Martina Boschetti Chiara Coluccio Paolo Giuffrida Giulia Gibiino Chiara Petraroli Carlo Fabbri Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved Medicina walled-off pancreatic necrosis pancreatic fluid collections EUS-guided drainage step-up approach LAMS double pigtail plastic stents |
| title | Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved |
| title_full | Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved |
| title_fullStr | Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved |
| title_full_unstemmed | Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved |
| title_short | Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved |
| title_sort | endoscopic ultrasound guided drainage of pancreatic fluid collections not all queries are already solved |
| topic | walled-off pancreatic necrosis pancreatic fluid collections EUS-guided drainage step-up approach LAMS double pigtail plastic stents |
| url | https://www.mdpi.com/1648-9144/60/2/333 |
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