Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo, São Paulo 05403000, Brazil.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital - Harvard Medical School, Boston, MA 02115, United States.
World J Gastroenterol. 2020 Dec 7;26(45):7104-7117. doi: 10.3748/wjg.v26.i45.7104.
Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or complicated. Within the last decade, endoscopic management of these collections endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous drainage. Proper understanding of anatomic landmarks, including assessment of the main pancreatic duct and any associated lesions - such as disruptions and strictures - are key to achieving clinical success, reducing the need for reintervention or recurrence, especially in cases with suspected disconnected pancreatic duct syndrome. Additionally, proper review of imaging and anatomic landmarks, including collection location, are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic stents. Pancreatography to adequately assess the main pancreatic duct may be performed by two methods: Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically retrograde cholangiopan-creatography. Despite the critical need to understand anatomy pancrea-tography and assess the main pancreatic duct, a standardized approach or uniform assessment strategy has not been described in the literature. Therefore, the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.
胰腺液体积聚是与急性或慢性胰腺炎相关的局部并发症，当出现症状和/或并发症时可能需要介入治疗。在过去十年中，这些液体积聚的内镜管理-经内镜超声引导的透壁引流已成为包裹性胰腺液体积聚的金标准治疗方法，与传统手术和经皮引流相比，具有更高的临床成功率和更低的发病率。正确理解解剖学标志，包括主胰管的评估和任何相关病变，如中断和狭窄，是实现临床成功、降低再次干预或复发的关键，尤其是在怀疑存在断开的胰管综合征的情况下。此外，正确评估影像学和解剖学标志，包括积液位置，对于确定胰腺支架的类型和大小以及使用长期透壁留置塑料支架的方法至关重要。可以通过两种方法进行胰管造影术来充分评估主胰管：一种是使用磁共振胰胆管成像进行非侵入性检查，另一种是通过内镜逆行胰胆管造影进行检查。尽管迫切需要了解解剖学、胰管造影术和评估主胰管，但文献中尚未描述标准化方法或统一的评估策略。因此，本综述的目的是阐明胰管造影术在经内镜治疗包裹性胰腺液体积聚中的作用，并提出一种新的分类系统，以帮助进行适当的评估和内镜治疗。
