Overview
Acute pancreatic fluid collections (APFCs), including pseudocysts and walled-off necrosis, are localized collections of fluid within or around the pancreas resulting from acute or chronic pancreatitis. These collections require intervention when symptomatic or at risk of complications 1.Diagnosis
Imaging studies (CT, MRI) essential for diagnosis and characterization of APFCs 1.
Endoscopic ultrasound (EUS) used to assess anatomy and guide drainage procedures 1.
Differentiation between pseudocysts and walled-off necrosis based on imaging characteristics and clinical context 1.Management
First-line Treatment: Endoscopic ultrasound-guided transmural drainage (EUS-TMD) for symptomatic collections 1.
- Use of metal stents, particularly lumen-apposing stents, is common 1.
Technical Considerations: Fluoroscopy guidance may not significantly alter outcomes compared to fluoroless techniques 1.
Follow-up: Regular imaging to monitor resolution and detect complications 1.Special Populations
No specific data provided regarding pregnancy, pediatrics, elderly, or comorbidities in managing APFCs 1.Key Recommendations
EUS-guided transmural drainage is effective for symptomatic acute pancreatic fluid collections, with high technical success rates 1 (Evidence: Strong).
The necessity of fluoroscopy during EUS-TMD remains uncertain; outcomes appear comparable with fluoroless techniques 1 (Evidence: Moderate).
Utilize metal stents, especially lumen-apposing stents, for drainage procedures 1 (Evidence: Moderate).References
1 Consiglieri CF, Gornals JB, Busquets J, Peláez N, Secanella L, De-La-Hera M et al.. Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study. Gastroenterologia y hepatologia 2018. link