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Endoscopic ultrasound-guided drainage of pancreatic fluid collections

World Journal of Gastrointestinal Endoscopy 2012年第11期4卷 479-488页

作者： Carlo Fabbri Carmelo Luigiano Antonella Maimone anna maria polifemo Ⅰlaria Tarantino Vincenzo Cennamo Unit of Gastroenterologyand Digestive Endoscopy AUSL Bologna Bellaria-Maggiore Hospital Unit of Gastroenterology and Digestive Endoscopy AUSL Bologna Bellaria-Maggiore Hospital Endoscopy Unit ISMETT/UPMC 90100 Palermo Italy

Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid collections include acute fluid collections, acute and chronic pancreatic pseudocysts, pancreatic abscesses and pancreatic necrosis. Before the introduction of linear endoscopic ultrasound (EUS) in the 1990s and the subsequent development of endoscopic ultrasound-guided drainage (EUS-GD) procedures, the available options for drainage in symptomatic PFCs included surgical drainage, percutaneous drainage using radiological guidance and conventional endoscopic transmural drainage. In recent years, it has gradually been recog-nized that, due to its lower morbidity rate compared to the surgical and percutaneous approaches, endoscopic treatment may be the preferred first-line approach for managing symptomatic PFCs. Endoscopic ultrasound-guided drainage has the following advantages, when compared to other alternatives such as surgical, per-cutaneous and non-EUS-guided endoscopic ***-GD is less invasive than surgery and therefore does not require general anesthesia. The morbidity rate is lower, recovery is faster and the costs are lower. EUS-GD can avoid local complications related to per-cutaneous drainage. Because the endoscope is placed adjacent to the fluid collection, it can have direct ac-cess to the fluid cavity, unlike percutaneous drainage which traverses the abdominal wall. Complications such as bleeding, inadvertent puncture of adjacent viscera, secondary infection and prolonged periods of drainage with resultant pancreatico-cutaneous fistulae may be avoided. The only difference between EUS and non-EUS drainage is the initial step, namely, gaining access to the pancreatic fluid collection. All the sub-sequent steps are similar, i.e., insertion of guide-wires with fluoroscopic guidance, balloon dilatation of the cystogastrostomy and insertion o

关键词： Endoscopic ultrasound-guided drainage Pancreatic fluid collections Pseudocysts Pancreatic abscesses Infected necrosis

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