Interventional endoscopy for the treatment of pancreatic pseudocyst and walled-off necrosis (with videos)

Abstract

Pancreatic pseudocysts and walled-off necrosis are typical late complications of acute pancreatitis, and they require drainage in symptomatic cases presenting with infection. Transgastrointestinal endoscopic treatment with endoscopic ultrasound-guided drainage has become common and yields a good treatment outcome for pancreatic pseudocyst. Walled-off necrosis, however, contains necrotic tissue, and thus many cases additionally require an invasive treatment that includes endoscopic necrosectomy. Methods that involve a procedure-specific large-diameter metal stent, additional endoscopic drainage techniques, and the hybrid approach method of adding percutaneous drainage have been described, and considerable advances in these methods have now made it possible to cure almost all cases of walled-off necrosis with endoscopic treatment alone. However, without being restricted to endoscopic treatments, a wide range of options including surgery should be considered as treatments for walled-off necrosis.

Keywords: Endoscopic necrosectomy; Endoscopic ultrasound-guided drainage; Hybrid approach; Step-up approach; Walled-off necrosis.