Pancreatic fluid collections and necrosectomy with plastic stents versus lumen-apposing stents.

Abstract

The incidence of hospitalizations for acute pancreatitis is rising, with 5%–15% of patients with pancreatitis developing pancreatic fluid collections (PFCs).[1,2] In addition to acute pancreatitis, other causes of PFCs include chronic injury, trauma, surgical resection, and/or injury to the pancreas during abdominal surgery.[3,4] Management paradigms for these collections, particularly if they are complicated by infected necrosis, have changed over the past decade. Advances in endoscopic tools have driven a new era of minimally invasive techniques to manage both pancreatic pseudocysts (PPs) and walled-off necrosis (WON). This step-up approach with initial interventions using less invasive procedures rather than surgical necrosectomy was described by van Santvoort et al. and has been associated with an overall decreased mortality, fewer number of complications, and lower healthcare costs.[2,5] The primarily liquid content of PP can be drained in a single endoscopic session with a transmural drain to allow for collapse and resolution. However, the solid, necrotic tissue contained within WON often does not drain as easily and has the potential of developing infection, requiring larger caliber transmural drains. Therefore, successful management of PFCs must be tailored based on the characteristics of the collection.