Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

Endoscopic drainage for pancreatic and peripancreatic fluidcollections (PFCs) has been increasingly used as a minimallyinvasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage(EUS-TD) has become the standard of care and a safeprocedure for nonsurgical PFC treatment. EUS-TD ensuresa safe puncture, avoiding intervening blood vessels. Singleor multiple plastic stents (combined with a nasocystic catheter)were used for the treatment of PFCs for EUS-TD. Morerecently, the use of covered self-expandable metallic stents(CSEMSs) has provided a safer and more efficient approachroute for internal drainage. We focused our review on thebest approach and stent to use in endoscopic drainage forPFCs. We reviewed studies of EUS-TD for PFCs based onthe original Atlanta Classification, including case reports,case series, and previous review articles. Data on clinicaloutcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreaticpseudocysts using CSEMSs. The treatment success and adverseevent rates were 94.6% and 21.1%, respectively. Themajority of complications were of mild severity and resolvedwith conservative therapy. A total of 56 patients underwentEUS-TD using CSEMSs for pancreatic abscesses or infectedwalled-off necroses. The treatment success and adverseevent rates were 87.8% and 9.5%, respectively. EUS-TD canbe performed safely and efficiently for PFC treatment. Largerdiameter CSEMSs without additional fistula tract dilation forthe passage of a standard scope are needed to access anddrain for PFCs with solid debris.

Endoscopic drainage for pancreatic and peripancreatic fluidcollections (PFCs) has been increasingly used as a minimallyinvasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage(EUS-TD) has become the standard of care and a safeprocedure for nonsurgical PFC treatment. EUS-TD ensuresa safe puncture, avoiding intervening blood vessels. Singleor multiple plastic stents (combined with a nasocystic catheter)were used for the treatment of PFCs for EUS-TD. Morerecently, the use of covered self-expandable metallic stents(CSEMSs) has provided a safer and more efficient approachroute for internal drainage. We focused our review on thebest approach and stent to use in endoscopic drainage forPFCs. We reviewed studies of EUS-TD for PFCs based onthe original Atlanta Classification, including case reports,case series, and previous review articles. Data on clinicaloutcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreaticpseudocysts using CSEMSs. The treatment success and adverseevent rates were 94.6% and 21.1%, respectively. Themajority of complications were of mild severity and resolvedwith conservative therapy. A total of 56 patients underwentEUS-TD using CSEMSs for pancreatic abscesses or infectedwalled-off necroses. The treatment success and adverseevent rates were 87.8% and 9.5%, respectively. EUS-TD canbe performed safely and efficiently for PFC treatment. Largerdiameter CSEMSs without additional fistula tract dilation forthe passage of a standard scope are needed to access anddrain for PFCs with solid debris.