Journal
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Volume 16, Issue 12, Pages 1851-+Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2018.03.021
Keywords
Pancreatic Fluid Collection; Walled-Off Necrosis; Pseudocyst; Cyst-Gastrostomy; Cyst-Duodenostomy; Necrosectomy
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Endoscopy has emerged as a mainstay in the management of pancreatic fluid collections (PFCs), representing an important advance in clinical medicine that has significantly improved the risk-benefit ratio of treating this complex patient population. While endoscopic pseudocyst drainage has generally supplanted surgical and percutaneous approaches, the optimal strategy for walled-off necrosis remains variable and multi-disciplinary despite an emerging trend from randomized trials favoring endoscopy. Although several issues pertaining to endoscopic drainage appear to have been settled - such as the use of endoscopic ultrasound - other pressing questions - including the optimal prosthesis and debridement strategy - remain unanswered, and rigorous investigation is needed. This review aims to provide an evidence-based but practical appraisal of the endoscopic drainage of PFCs through the perspective of the author, with an emphasis on relevant clinical and endoscopic considerations and important research questions.
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