Ang Tiing Leong, Teoh Anthony Y B
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Dig Endosc. 2017 May;29(4):463-471. doi: 10.1111/den.12797. Epub 2017 Feb 1.
Endoscopic ultrasound (EUS)-guided drainage is now firmly established as the best option for drainage of walled-off pancreatic fluid collections (PFC). It has high clinical efficacy, similar to surgical and percutaneous approaches, but with lower morbidity and costs. It is superior to non-EUS-guided approaches because even collections without endoluminal bulging can be successfully drained. Transmural drainage alone is sufficient for pseudocysts, but in the context of walled-off pancreatic necrosis (WON), adjunctive direct endoscopic necrosectomy (DEN) may be required. Traditionally, double pigtail plastic stents (PS) were used for transmural drainage, but, recently, fully covered self-expandable metallic stents (FCSEMS) customized for PFC drainage have become available and are increasingly used, especially in the management of WON, because the larger-diameter stent facilitates drainage and insertion of an endoscope into the WON cavity for DEN. The present review will discuss the evidence for EUS-guided drainage and DEN, the technical problems involved, and the roles of PS and FCSEMS in PFC drainage.
内镜超声（EUS）引导下引流现已牢固确立为有包裹性胰腺液体积聚（PFC）引流的最佳选择。它具有很高的临床疗效，与手术和经皮引流方法相似，但发病率和成本较低。它优于非EUS引导的方法，因为即使没有腔内隆起的液体积聚也能成功引流。单纯经壁引流对于假性囊肿就足够了，但在有包裹性胰腺坏死（WON）的情况下，可能需要辅助直接内镜坏死组织切除术（DEN）。传统上，双猪尾塑料支架（PS）用于经壁引流，但最近，专门为PFC引流定制的全覆膜自膨式金属支架（FCSEMS）已可供使用且越来越多地被采用，尤其是在WON的治疗中，因为较大直径的支架便于引流以及将内镜插入WON腔进行DEN。本综述将讨论EUS引导下引流和DEN的证据、所涉及的技术问题以及PS和FCSEMS在PFC引流中的作用。
