title: Endoscopic ultrasonography-guided drainage of pancreatic fluid collections.
abstract: Endoscopic ultrasound (EUS)-guided drainage is now firmly established as the best option for drainage of walled-off pancreatic fluid collections (PFC). It has high clinical efficacy, similar to surgical and percutaneous approaches, but with lower morbidity and costs. It is superior to non-EUS-guided approaches because even collections without endoluminal bulging can be successfully drained. Transmural drainage alone is sufficient for pseudocysts, but in the context of walled-off pancreatic necrosis (WON), adjunctive direct endoscopic necrosectomy (DEN) may be required. Traditionally, double pigtail plastic stents (PS) were used for transmural drainage, but, recently, fully covered self-expandable metallic stents (FCSEMS) customized for PFC drainage have become available and are increasingly used, especially in the management of WON, because the larger-diameter stent facilitates drainage and insertion of an endoscope into the WON cavity for DEN. The present review will discuss the evidence for EUS-guided drainage and DEN, the technical problems involved, and the roles of PS and FCSEMS in PFC drainage.
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
authors.forename: Tiing Leong
authors.identifier: http://orcid.org/0000-0001-9993-8549
authors.initials: TL
authors.lastname: Ang
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Y B
authors.initials: AYB
authors.lastname: Teoh
mesh_terms: D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D010189:Pancreatic Juice; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: endoscopic necrosectomy; endoscopic ultrasound; pseudocyst; self expandable metallic stents; walled-off necrosis