Journal List > Korean J Gastroenterol > v.72(3) > 1101291

Yoon, Chang, and Lee: Treatment of Pancreatic Fluid Collections

Abstract

Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.

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Fig. 1.
Display of different types of drain tubes. (A) Plastic Stent (Cook Medical, Bloomington, IN, USA), (B) Solus stent (Cook Medical), (C) Axios stent (Boston Scientific, Marlborough, MA, USA), (D) Spaxus stent (Taewoong Medical, Gimpo, Korea), (E) Nagi stent (Taewoong Medical).
kjg-72-97f1.tif
Fig. 2.
Procedure of EUS-guided pseudocyst drainage. (A) Infected cyst found at tail, the cyst wall protruded at the posterior side of the stomach on gastroscopy (B) and EUS (C). Transmural puncture was done under EUS-guided technique (D-F), the guidewire was introduced into the cyst (G, H) and then balloon dilatation of the cystic wall was performed (I, J), finally 2 double pigtail plastic stents were inserted (K, L). EUS, endoscopic ultrasonography.
kjg-72-97f2.tif
Table 1.
Endoscopic Treatment of a Pancreas Pseudocyst
  Study number Drainage procedure used Drain used Clinical success Technical success Complication
Hookey et al. (2006)22 116 Conventional Stents 88% 88% 11% complication rate
Antillon et al. (2006)23 33 EUS-guided Double-pigtail stent 94% 82% 2 major complications, 3 minor complications
Azar et al. (2006)24 23 EUS-guided Double-pigtail stent 91% 91%  
Lopes et al. (2007)25 51 EUS-guided Straight/double-pigtail stent 94% 94% 17.7% stent migration/obstruction
Barthet et al. (2008)26 50 EUS-guided Double-pigtail stent/straight polyethylene 90% 98% 18% morbidity, 5 superinfections
Talreja et al. (2008)27 18 EUS-guided FCSEMS 95% 78% 5 superinfection, 2 bleeding, 1 and inner migration
Berzosa et al. (2012)28 7 EUS-guided FCSEMS 100% 83%  
Fabbri et al. (2012)29 22 EUS-guided FCSEMS 77% 77%  
Penn et al. (2012)30 20 EUS-guided FCSEMS 70% 70% 2 pseudocyst infection, 1 post transmural drainage fever and post-ERCP pancreatitis
Itoi et al. (2012)31 15 EUS-guided Axios stent®a 100% 100%  
Weilert et al. (2012)32 18 EUS-guided FCSEMS 78% 78%  
Varadarajulu et al. (2013)33 20 Endoscopic Plastic stents 95% 90%  
    cystogastrostomy        
Sarkaria et al. (2014)34 17 EUS-guided esophageal-FCSEMS 88% 88% 1 perforation during tract dilation
Shah et al. (2015)35 33 EUS-guided Axios stent®a 91% 93%  
Walter et al. (2015)36 61 EUS-guided Axios stent®a 93% 98% 3 abdominal pain, spontaneous stent migration, 1 back pain, 1 access-site infection, and stent dislodgement, 3 stent migration, 3 stent dislodgement during necrosectomy, 2 stent removal during surgery, or 1 refusal by the patient
Mukai et al. (2015)37 21 EUS-guided/ DEN Nagi stent®b 100% 100% 1 psuedocyst recurrence in cystogramy
Rinninella et al. (2015)38 18 EUS-guided Axios stent®a 100%    
Sharaiha et al. (2015)15 230 EUS-guided 118 plastic stents/112 FCSEMS 75–90% <90%  

EUS, endoscopic ultrasonography; FCSEMS, full covered self expandable metal stent; ERCP, endoscopic retrograde cholangiopancreatography; DEN, direct endoscopic necrosectomy.

a Axios Stent® (Boston Scientific, Marlborough, MA, USA)

b Nagi stent® (Taewoong Medical, Gimpo, Korea).

Table 2.
Endoscopic Treatment of Wall-off Necrosis
  Study number Drainage procedure used Drain used Clinical success Technical success Complication
Seewald et al. (2005)39 13 DEN Double-pigtail stent 91% 91% 4 minor bleeding after balloon dilation, necrosectomy
Charnley et al. (2006)40 13 DEN Double-pigtail stents 92.3% 92.3%  
Voermans et al. (2007)41 25 DEN Double-pigtail stents 93% 93% 2 surgery, 1 hemorrhage, 1 perforation of cyst wall
Papachristou et al. (2007)42 53 DEN Double-pigtail stents 81% 81% 12 required operation after initial endoscopic drainage/debridement, due to 3 persistence of WOPN, 2 recurrence of a PFCs, 2 cutaneous fistula formation, or 1 technical failure, persistence of pancreatic pain, colonic obstruction, perforation, and flank abscess
Escourrou et al. (2008)43 13 DEN Double-pigtail stents 100% 100% 3 bleeding, 3 transient aggravation of sepsis
Seifert et al. (2009)44 93 DEN Multiple stents 80% 80%  
Gardner et al. (2009)45 45 DEN and EUS-guided drainage Multiple stents 45% DEN 88%, standard endoscopy 13 bleeding, 5 perforations of the necrosis, 2 fistular formation, 2 air embolism, 2 complications at ohter organs
          drainage 45%  
Gardner et al. (2011)46 104 DEN Multiple stents 91% 91% 14%; included 5 retrogastric perforations/pneumoperitoneum
Attam et al. (2014)47 10 DEN and transmural drain Novel large-bore esophageal FCSEMS 90% 100%  
Smoczyń ski et al. (2014)18 112 Endoscopic drainage Multiple stents 84% 93% 19 stoma bleeding, 4 GI perforation, 2 collection perforation, 1 sepsis, 3 stent migration
Sarkaria et al. (2014)34 17 EUS-guided Esohageal FCSEMS 83% 83%  
Mukai et al. (2015)37 8 DEN Nagi stent®a 100% 100%  
Rinninella et al. (2015)38 52 EUS guided Axios stent®b 90.4% 100% 3 surgery due to infection, 1 perforated wall
Walter et al. (2015)36 46 EUS guided Axios stent®b 81% 81% 9%

DEN, direct endoscopic necrosectomy; WOPN, walled-off pancreatic necrosis; PFC, pancreatic fluid collection; EUS, endoscopic ultrasonography; FCSEMS, full covered self expandable metal stent; GI, gastrointestinal.

a Nagi stent® (Taewoong Medical, Gimpo, Korea)

b Axios Stent® (Boston Scientific, Marlborough, MA, USA).

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In Seok Lee
https://orcid.org/0000-0002-1127-1522

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