Management of pancreatic fluid collections: A comprehensive review of the literature
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...
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Published in | World journal of gastroenterology : WJG Vol. 22; no. 7; pp. 2256 - 2270 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Baishideng Publishing Group Inc
21.02.2016
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Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 Author contributions: Desai A, Karia K, Tyberg A, Gabr M and Doshi R contributed to acquisition of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content; Sharaiha RZ and Gaidhane M contributed to acquisition of data, interpretation of data, critical revision of the manuscript for important intellectual content, study coordination; Kahaleh M contributed to study concept and design, acquisition of data, critical revision of the manuscript for important intellectual content, study supervision. Correspondence to: Michel Kahaleh, MD, FASGE, Chief, Professor, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY 10021, United States. mkahaleh@gmail.com Telephone: +1-646-9624000 Fax: +1-646-9620110 |
ISSN: | 1007-9327 2219-2840 |
DOI: | 10.3748/wjg.v22.i7.2256 |