Shah Apeksha, Denicola Richard, Edirisuriya Cynthia, Siddiqui Ali A
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Curr Treat Options Gastroenterol. 2017 Dec;15(4):576-586. doi: 10.1007/s11938-017-0161-z.
Pancreatic fluid collections are a frequent complication of acute pancreatitis. The revised Atlanta criterion classifies chronic fluid collections into pseudocysts and walled-off pancreatic necrosis (WON). Symptomatic PFCs require drainage options that include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, minimally invasive endoscopic drainage has now become the preferred approach. An endoscopic ultrasonography (EUS)-guided approach for pancreatic fluid collection drainage is now the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WON. Direct endoscopic necrosectomy is often required in WON. Lumen apposing metal stents allow for direct endoscopic necrosectomy and debridement through the stent lumen and are now preferred in these patients. Endoscopic retrograde cholangiopancreatography with pancreatic duct exploration should be performed concurrent to PFC drainage in patients with suspected PD disruption. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Ideally, pancreatic ductal disruption should be bridged with endoscopic stenting.
胰液积聚是急性胰腺炎常见的并发症。修订后的亚特兰大标准将慢性胰液积聚分为假性囊肿和包裹性胰腺坏死（WON）。有症状的胰液积聚需要采用包括手术、经皮或内镜等方式进行引流。随着更新、更先进的内镜工具和技术的出现，微创内镜引流现已成为首选方法。内镜超声（EUS）引导下的胰液积聚引流方法是目前首选的内镜方法。塑料支架和金属支架均有效且安全；然而，金属支架可能具有优势，尤其是在感染性假性囊肿和包裹性胰腺坏死中。包裹性胰腺坏死通常需要进行直接内镜坏死组织清除术。管腔贴附金属支架可通过支架管腔进行直接内镜坏死组织清除术和清创，目前在这些患者中是首选。对于疑似胰管破裂的患者，在进行胰液积聚引流的同时应进行内镜逆行胰胆管造影并探查胰管。胰管破裂与胰腺炎严重程度增加、胰腺炎复发风险增加及长期并发症相关，且引流后胰液积聚消退率降低。理想情况下，胰管破裂应通过内镜支架置入进行桥接。
