Guo Jintao, Saftoiu Adrian, Vilmann Peter, Fusaroli Pietro, Giovannini Marc, Mishra Girish, Rana Surinder S, Ho Sammy, Poley Jan-Werner, Ang Tiing Leong, Kalaitzakis Evangelos, Siddiqui Ali A, De La Mora-Levy Jose G, Lakhtakia Sundeep, Bhutani Manoop S, Sharma Malay, Mukai Shuntaro, Garg Pramod Kumar, Lee Linda S, Vila Juan J, Artifon Everson, Adler Douglas G, Sun Siyu
Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China.
Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania.
Endosc Ultrasound. 2017 Sep-Oct;6(5):285-291. doi: 10.4103/eus.eus_85_17.
There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-off necrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peri-pancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.
关于如何进行内镜超声（EUS）引导下假性囊肿引流和内镜坏死组织清除术，目前尚无共识。本次调查针对EUS杂志编辑委员会成员展开，以描述他们在实施该手术时的操作方法。这是一项于2017年5月在全球范围内针对EUS杂志编辑委员会成员开展的多机构调查。获得了对一份关于EUS引导下假性囊肿引流和内镜坏死组织清除术操作的22个问题调查问卷的回复。22位内镜医师对问卷的回复如下：72.7%（16/22）认为，对于胰腺包裹性坏死（WON）患者，管腔对合金属支架（LAMS）应作为创建内镜下囊肿肠吻合术的标准治疗方法；95.5%（21/22）推荐使用大直径（d = 15 mm）的LAMS对WON患者进行引流；54.5%（12/22）在将LAMS置入WOPN后不会对其进行扩张；86.4%（19/22）不会在创建囊肿肠吻合术的同一手术过程中进行内镜坏死组织清除术；45.5%（10/22）建议使用诸如稀释过氧化氢等药物对WON患者的胰腺周围液体聚集（PFC）腔进行灌洗；45.5%（10/22）认为在初次引流后，对WON进行灌洗需要一根鼻囊肿管或其他导管。EUS引导下引流后推荐的内镜坏死组织清除术的平均最佳间隔时间为6.23天。接受内镜坏死组织清除术的患者推荐的重复成像的平均最佳间隔时间为12.32天。推荐的LAMS取出的平均时间为4.59周。这是首次关于EUS引导下假性囊肿引流和内镜坏死组织清除术操作的全球调查。操作方法存在很大差异，迫切需要进行随机研究以确立治疗这种疾病的最佳方法。同时也迫切需要建立最佳实践共识。
