title: Management of pancreatic fluid collections: A comprehensive review of the literature.
abstract: Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting.
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Kunal
authors.initials: K
authors.lastname: Karia
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Moamen
authors.initials: M
authors.lastname: Gabr
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Amit
authors.initials: A
authors.lastname: Desai
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Rushabh
authors.initials: R
authors.lastname: Doshi
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Amy Tyberg, Kunal Karia, Moamen Gabr, Amit Desai, Rushabh Doshi, Monica Gaidhane, Reem Z Sharaiha, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D003646:Debridement / Q000009:adverse effects; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004750:Enteral Nutrition / Q000009:adverse effects; D006801:Humans; D009336:Necrosis; D010189:Pancreatic Juice / Q000378:metabolism* / Q000382:microbiology; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
keywords: Pancreatic fluid collection; Pancreatitis; Pseudocyst; Walled-off pancreatic necrosis