Bharath Pardhu Neelam, Rana Surinder Singh
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Dig Dis Sci. 2024 May;69(5):1571-1582. doi: 10.1007/s10620-024-08347-3. Epub 2024 Mar 25.
Endoscopic transmural drainage is usually performed for symptomatic well-encapsulated walled-off necrosis (WON) that usually develops in the delayed phase (> 4 weeks after disease onset) of acute necrotising pancreatitis (ANP). Endoscopic drainage is usually not advocated in the early (< 4 weeks after disease onset) stage of illness because of the risk of complications due to an incompletely formed encapsulating wall and poor demarcation of viable from necrotic tissue. However, emerging data from expert tertiary care centres over the last few years shows that the early endoscopic transluminal drainage approach is effective and safe. The development of lumen-apposing metal stents and better accessories for endoscopic necrosectomy has fuelled the expansion of indications of endoscopic drainage of pancreatic necrosis. However, early endoscopic drainage is associated with higher rates of adverse events; therefore, careful patient selection is paramount. This article will review the current indications, techniques and outcomes of early endoscopic transluminal drainage in pancreatic necrotic collections.
内镜经壁引流通常用于治疗有症状的、包膜完整的包裹性坏死（WON），这种情况通常发生在急性坏死性胰腺炎（ANP）的延迟期（发病后>4周）。由于在疾病早期（发病后<4周），包裹壁未完全形成，坏死组织与存活组织分界不清，进行内镜引流会有并发症风险，因此通常不提倡在疾病早期进行内镜引流。然而，过去几年来自专业三级护理中心的新数据表明，早期内镜经腔引流方法是有效且安全的。管腔贴合金属支架的发展以及用于内镜坏死组织清除术的更好的附件推动了胰腺坏死内镜引流适应证的扩大。然而，早期内镜引流与更高的不良事件发生率相关；因此，谨慎选择患者至关重要。本文将综述胰腺坏死性积液早期内镜经腔引流的当前适应证、技术及结果。
