ENDOSCOPIC MANAGEMENT OF PERIPANCREATIC FLUID COLLECTION

Abstract

Interventional treatment is indicated for patients with infected and symptomatic peripancreatic fluid collection (PFC). Endoscopic drainage is desirable as it is less invasive than surgical drainage, and either endoscopic transpapillary drainage or endoscopic ultrasound-guided transluminal drainage (EUS-TD) would be selected depending on the etiology. EUS-TD followed by direct endoscopic necrosectomy (DEN) has been established as a first-line therapy, and the lumen-apposing metal stent (LAMS) has been developed to improve treatment outcomes in the endoscopic management of PFC. Although DEN is effective and requires a relatively short treatment period, it can cause serious complications. Therefore, patients should be carefully selected for EUS-TD followed by DEN. In the endoscopic therapy of PFC, the step-up approach is recommended in which EUS-TD is performed first and DEN would be considered if EUS-TD is not effective.