Alali Ali, Mosko Jeffrey, May Gary, Teshima Christopher
The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, ON, Canada.
Clin Endosc. 2017 Mar;50(2):117-125. doi: 10.5946/ce.2017.045. Epub 2017 Mar 30.
Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.
重症急性胰腺炎常并发胰液积聚（PFCs），这可能与显著的发病率和死亡率相关。鉴于结局和管理方面存在显著差异，准确将这些积聚分类为假性囊肿或包裹性坏死（WON）至关重要。针对PFCs的干预措施已越来越多地转向侵入性较小的策略，内镜超声（EUS）引导下的方法已被证明与侵入性更强的手术技术一样安全且效果相同。近年来，许多新进展提高了EUS引导下干预措施的安全性和有效性，如管腔贴附金属支架（LAMS）的引入、直接内镜坏死组织清除术（DEN）以及多种其他辅助技术。尽管有这些进展，但PFCs的治疗，尤其是感染性WON的治疗，仍然与显著的发病率和死亡率相关。在本文中，我们在回顾该领域的最新进展和争议的同时，讨论EUS引导下对PFCs的管理。我们最后总结了我们自己管理PFCs的方法。
