Rana Randeep, Mahapatra Soumya Jagannath, Garg Pramod Kumar
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, 110 002, India.
Indian J Gastroenterol. 2025 Apr 28. doi: 10.1007/s12664-025-01755-x.
Acute pancreatitis is an acute inflammatory disease, which may be associated with pancreatic and peri-pancreatic necrosis and development of (peri)pancreatic fluid collections (PFCs). Interventions in acute pancreatitis have evolved over the years with a paradigm shift from open surgical drainage and necrosectomy to minimally invasive approaches. Depending on the presence of necrosis, the PFCs may be acute necrotic collections or acute pancreatic fluid collections, which evolve over a period of three to four weeks to walled-off necrosis and pseudocysts, respectively. Patients with symptomatic and infected PFCs require drainage. In general, drainage should be delayed beyond three to four weeks when the collection wall has matured and the necrotic debris is liquefied. However, some patients may merit early drainage (within the first three to four weeks), if they have suspected infected pancreatic necrosis and worsening organ dysfunction despite antibiotics and supporting therapy. Endoscopic transmural drainage and necrosectomy have now emerged as the most favored treatment modality in suitable pancreatic collections located predominantly in the lesser sac. Being minimally invasive, per-oral endoscopic direct necrosectomy is as effective as surgical necrosectomy in patients with infected necrotic collections but with fewer adverse events. Percutaneous endoscopic necrosectomy is an important addition to our armamentarium for laterally placed collections as an effective alternative to surgical video-assisted retroperitoneal debridement. The current review provides an overview of the evolution, indications, approaches, techniques and outcomes of endoscopic interventions in the management of pancreatic fluid collections associated with acute pancreatitis. Future direction for better outcomes has been highlighted.
急性胰腺炎是一种急性炎症性疾病，可能与胰腺及胰周坏死以及胰（周）液体积聚（PFCs）的形成有关。多年来，急性胰腺炎的治疗手段不断发展，经历了从开放手术引流和坏死组织清除术到微创方法的模式转变。根据坏死情况，PFCs可能是急性坏死性液体积聚或急性胰液积聚，分别在三到四周的时间内演变为包裹性坏死和假性囊肿。有症状且感染的PFCs患者需要进行引流。一般来说，当积液壁成熟且坏死碎片液化后，引流应推迟至三到四周以后。然而，一些患者如果怀疑有感染性胰腺坏死且尽管使用了抗生素和支持治疗但器官功能仍在恶化，则可能需要早期引流（在最初的三到四周内）。内镜经壁引流和坏死组织清除术现已成为主要位于小网膜囊的合适胰腺积液最受欢迎的治疗方式。经口内镜直视坏死组织清除术具有微创性，在感染性坏死性积液患者中与手术坏死组织清除术效果相同，但不良事件较少。经皮内镜坏死组织清除术是我们治疗手段的重要补充，对于外侧放置的积液，它是手术电视辅助腹膜后清创术的有效替代方法。本综述概述了内镜干预在治疗与急性胰腺炎相关的胰液积聚中的发展、适应证、方法、技术和结果。还强调了为取得更好疗效的未来方向。
