Clinical Pancreatology for Practising Gastroenterologists and Surgeons. Группа авторов

it occurs, resuscitation and the urgent assistance of an interventional radiologist or experienced surgeon is required. Late bleeding appears more common with LAMS [12]. LAMS can induce both neovascularization and overgrowth of adjacent retroperitoneal tissues leading to bleeding at the time of removal, hence the need for earlier retrieval than plastic stents. Additionally, collapse of the cyst cavity can bring vessels into contact with the metal flange leading to abrasion and late bleeding.

      Perforation due to stent misplacement is uncommon with EUS guidance in expert hands. However, rapid decompression of a large collection (particularly if the wall is not fully mature and adherent) may lead to dehiscence of the cyst wall from the stomach or duodenum and a clinically significant leak. This is less likely when a LAMS is used. ERCP and transpapillary drainage is associated with the additional risk of pancreatitis.

Conclusion

      Endoscopy is well established as an important tool in the armamentarium of the multidisciplinary team managing pancreatic fluid collections. Despite improvements in technique and devices reflecting the complexity of the disease process, endoscopic drainage remains associated with significant morbidity and potential for mortality and careful patient selection and assesment is mandatory.

References

      1 1 Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62(1):102–111.

      2 2 Muthusamy VR, Chandrasekhara V, Acosta RD, et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83(3):481–488.

      3 3 Arvanitakis M, Dumonceau J‐M, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence‐based multidisciplinary guidelines. Endoscopy 2018; 50(5):524–546.

      4 4 Dumonceau J‐M, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, updated August 2018. Endoscopy 2019; 51(2):179–193.

      5 5 Teoh AYB, Dhir V, Kida M, et al. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67(7):1209–1228.

      6 6 Elmunzer BJ. Endoscopic drainage of pancreatic fluid collections. Clin Gastroenterol Hepatol 2018; 16(12):1851–1863.e3.

      7 7 Agalianos C, Passas I, Sideris I, et al. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol 2018; 3:18.

      8 8 Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145(3):583–590.e1.

      9 9 Varadarajulu S, Christein JD, Tamhane A, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68(6):1102–1111.

      10 10 Park D, Lee S, Moon S‐H, et al. Endoscopic ultrasound‐guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009; 41(10):842–848.

      11 11 Chen Y‐I, Khashab M, Adam V, et al. Plastic stents are more cost‐effective than lumen‐apposing metal stents in management of pancreatic pseudocysts. Endosc Int Open 2018; 6(7):E780–E788.

      12 12 Brimhall B, Han S, Tatman PD, et al. Increased incidence of pseudoaneurysm bleeding with lumen‐apposing metal stents compared to double‐pigtail plastic stents in patients with peripancreatic fluid collections. Clin Gastroenterol Hepatol 2018; 16(9):1521–1528.

      13 13 Yang J, Chen Y‐I, Friedland S, et al. Lumen‐apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study. Endoscopy 2019; 51(11):1035–1043.

      14 14 Bang JY, Wilcox CM, Navaneethan U, et al. Impact of disconnected pancreatic duct syndrome on the endoscopic management of pancreatic fluid collections. Ann Surg 2018; 267(3):561–568.