Treatment of Pancreatic Fluid Collections

Seung Bae Yoon; Jae Hyuck Chang; In Seok Lee

doi:10.4166/kjg.2018.72.3.97

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

Review Article

Korean J Gastroenterol 2018;72(3):97-103.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.72.3.97

Treatment of Pancreatic Fluid Collections

Seung Bae Yoon, Jae Hyuck Chang, In Seok Lee

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: In Seok Lee, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: +82-2-2258-6022, Fax: +82-2-2258-2055, E-mail: isle@catholic.ac.kr, ORCID: https://orcid.org/0000-0002-1127-1522

Received 23 August 2018 Revised 13 September 2018 Accepted 14 September 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pancreatic pseudocyst, Necrosis, Endosonography, Pancreatitis

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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).

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.

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