New Insight of EUS-Guided Transluminal Drainage for Pancreatic and Peripancreatic Fluid Collections

  • Atsushi IrisawaEmail author
  • Akane Yamabe
  • Ai Sato
  • Goro Shibukawa


Endoscopic ultrasound (EUS)-guided drainage, in which accumulated pancreatic and peripancreatic fluid collections are approached directly through the digestive tract, has been widely performed. This therapy is a procedure that allows for simple, reliable, and effective drainage without putting any burden on the pancreatic parenchyma. In addition, for cases in which elimination or remission of the lesions cannot be achieved with EUS-guided transgastric drainage alone, endoscopic necrosectomy is also carried out. However, these therapies are associated with a relatively high incidence of adverse events, and therefore, the indications must be fully considered, and the procedure must be mastered before it is performed.


Walled-off necrosis Pancreatic pseudocyst EUS-guided drainage Endoscopic necrosectomy 


  1. 1.
    Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg. 1993;128:586–90.CrossRefGoogle Scholar
  2. 2.
    Baron TH, Thaggard WG, Morgan DE, et al. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology. 1996;111:755–64.CrossRefPubMedGoogle Scholar
  3. 3.
    Baron TH, Morgan DE. Current concepts: acute necrotizing pancreatitis. N Engl J Med. 1999;340:1412–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Klöppel G. Pseudocysts and other non-neoplastic cyst of the pancreas. Semin Diagn Pathol. 2000;17:7–15.PubMedGoogle Scholar
  5. 5.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS, Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.CrossRefGoogle Scholar
  6. 6.
    Miyake H, Harada H, Kunichika K, et al. Clinical course and prognosis of chronic pancreatitis. Pancreas. 1987;2:378–85.CrossRefPubMedGoogle Scholar
  7. 7.
    Irisawa A, Shibukawa G, Hikichi T, et al. Interventional EUS for pancreatic pseudocyst and walled-off necrosis. Nihon Shokakibyo Gakkai Zasshi. 2013;110:575–84. (in Japanese)PubMedGoogle Scholar
  8. 8.
    Vitas GJ, Sarr MG. Selected management of pancreatic pseudocysts: operative versus expectant management. Surgery. 1992;111:123–30.PubMedGoogle Scholar
  9. 9.
    Yeo CJ, Bastidas JA, Lynch-Nyhan A, et al. The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet. 1990;170:411–7.PubMedGoogle Scholar
  10. 10.
    Bradley EL, Clements JL Jr, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management. Am J Surg. 1979;137:135–41.CrossRefPubMedGoogle Scholar
  11. 11.
    O’Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results. Am J Surg. 1985;150:680–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Imamura H, Irisawa A, Takagi T, et al. Two cases of pancreatic abscess associated with penetration to the gastrointestinal tract during treatment using endoscopic ultrasound-guided drainage. Fukushima J Med Sci. 2007;53:39–49.CrossRefPubMedGoogle Scholar
  13. 13.
    Besselink MG, Verwer TJ, Schoenmaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg. 2007;142:1194–201.CrossRefGoogle Scholar
  14. 14.
    Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Munn JS, Aranha GV, Greenlee HB, et al. Simultaneous treatment of chronic pancreatitis and pancreatic pseudocyst. Arch Surg. 1987;122:662–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Will U, Wanzar C, Gerlach R, et al. Interventional ultrasound-guided procedures in pancreatic pseudocysts, abscesses and infected necrosis treatment algorithm in a large single-center study. Ultraschall Med. 2011;32:176–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Seewald S, Ang TL, Kida M, Teng KY, Soehendra N, EUS 2008 Working Group. Evaluation of EUS-guided drainage of pancreatic-fluid collections (with video). Gastrointest Endosc. 2009;69:S13–21.CrossRefPubMedGoogle Scholar
  18. 18.
    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;68:1102–11.CrossRefPubMedGoogle Scholar
  19. 19.
    Park DH, Lee SS, Moon SH, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy. 2009;41:842–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Gardner TB, Chahal P, Papachristou GI, et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc. 2009;69:1085–94.CrossRefPubMedGoogle Scholar
  21. 21.
    Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307:1053–61.CrossRefGoogle Scholar
  22. 22.
    Haghshenasskashani A, Laurence JM, Kwan V, et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011;25:3724–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Fogel EL. Endoscopic pancreatic necrosectomy. J Gastrointest Surg. 2011;15:1098–100.CrossRefPubMedGoogle Scholar
  24. 24.
    Van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.CrossRefGoogle Scholar
  25. 25.
    Giovannini M. What is the best endoscopic treatment for pancreatic pseudocysts? Gastrointest Endosc. 2007;65:620–3.CrossRefPubMedGoogle Scholar
  26. 26.
    Yasuda I, Iwata K, Mukai T, et al. EUS-guided pancreatic pseudocyst drainage. Dig Endosc. 2009;21:S82–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Itoi T, Itokawa F, Tsuchiya T, et al. EUS-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique. Dig Endosc. 2009;21:S53–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Siddiqui AA, Dewitt JM, Strongin A, et al. Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain. Gastrointest Endosc. 2013;78:589–95.CrossRefPubMedGoogle Scholar
  29. 29.
    Suzuki R, Irisawa A, Bhutani MS, et al. Ultrathin endoscope-guided trangastric nasocystic irrigation tube placement to manage paracolic gutter extension of pancreatic necrosis. Gastrointest Endosc. 2012;76:457–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Varadarajulu S, Phadnis M, Christein J, et al. Multiple transluminal gateway technique for EUS-guided drainage of symptomatic wall-off pancreatic necrosis. Gastrointest Endosc. 2011;74:74–80.CrossRefPubMedGoogle Scholar
  31. 31.
    Mukai S, Itoi T, Sofuni A, et al. Novel single transluminal gateway transcystic multiple drainages after EUS-guided drainage for complicated multilocular walled-off necrosis (with videos). Gastrointest Endosc. 2014;79:531–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Talreja JP, Shami VM, Ku J, et al. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents. Gastrointest Endosc. 2008;68:1199–203.CrossRefPubMedGoogle Scholar
  33. 33.
    Penn DE, Draganov PV, Wagh MS, et al. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc. 2012;76:679–84.CrossRefPubMedGoogle Scholar
  34. 34.
    Fabbri C, Luigiano C, Cennamo V, et al. Endoscopic ultrasound-guided transmural drainage of infected Pancreatic fluid collections with placement of covered self-expanding metal stents: a case series. Endoscopy. 2012;44:429–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Weilert F, Binmoeller KF, Shah JN, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy. 2012;44:780–3.CrossRefPubMedGoogle Scholar
  36. 36.
    Shah RJ, Shah JN, Waxman I, et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol. 2015;13:747–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Saxena P, Singh VK, Messallam A, et al. Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video). Gastrointest Endosc. 2014;80:319–24.CrossRefPubMedGoogle Scholar
  38. 38.
    Walter D, Will U, Sanchez-Yague A, et al. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study. Endoscopy. 2015;47:63–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Itoi T, Binmoeller KF, Shah J, et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography guided pancreatic pseudocyst and gallbladder drainage (with video). Gastrointest Endosc. 2012;75:870–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Itoi T, Reddy DN, Yasuda I. New fully-covered self-expandable metal stent for EUS-guided intervention in infectious walled-off pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci. 2013;20:403–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Yamamoto N, Isayama H, Kawakami H, et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc. 2013;77:809–14.CrossRefPubMedGoogle Scholar
  42. 42.
    Bapaye A, Itoi T, Kongkam P, et al. New fully covered large-bore wide-flare removable metal stent for drainage of pancreatic fluid collections: results of a multicenter study. Dig Endosc. 2015;27:499–504.CrossRefPubMedGoogle Scholar
  43. 43.
    Hikichi T, Irisawa A, Takagi T, et al. A case of transgastric gallbladder puncture as a complication during endoscopic ultrasound-guided drainage of a pancreatic pseudocyst. Fukushima J Med Sci. 2007;53:11–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Monkemuller KE, Baron TH, Morgan DE. Transmural drainage of pancreatic fluid collections without electrocautery using the Seldinger technique. Gastrointest Endosc. 1998;48:195–200.CrossRefPubMedGoogle Scholar
  45. 45.
    Yasuda I, Nakashima M, Iwai T, et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis (The JENIPaN study). Endoscopy. 2013;45:627–34.CrossRefPubMedGoogle Scholar
  46. 46.
    Seifert H, Biermer M, Schmitt W, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicenter study with long-term follow-up (the GEPARD study). Gut. 2009;58:1260–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Seewald S, Groth S, Omar S, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc. 2005;62:92–100.CrossRefPubMedGoogle Scholar
  48. 48.
    Charnley RM, Lochan R, Gray H, et al. Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis. Endoscopy. 2006;38:925–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Escourrou J, Shehab H, Buscail L, et al. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg. 2008;248:1074–80.CrossRefPubMedGoogle Scholar
  50. 50.
    Coelho D, Ardengh JC, Eulalio JM, et al. Management of infected and sterile pancreatic necrosis by programmed endoscopic necrosectomy. Dig Dis. 2008;26:64–9.CrossRefGoogle Scholar
  51. 51.
    Raczynski S, Teich N, Borte G, et al. Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos). Gastrointest Endosc. 2006;64:420–4.CrossRefPubMedGoogle Scholar
  52. 52.
    Jürgensen C, Neser F, Boese-Landgraf J, et al. Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary? Surg Endosc. 2012;26:1359–63.CrossRefPubMedGoogle Scholar
  53. 53.
    Gardner TB, Coelho-Prabhu N, Gordon SR, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc. 2011;73:718–26.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Atsushi Irisawa
    • 1
    Email author
  • Akane Yamabe
    • 1
  • Ai Sato
    • 1
  • Goro Shibukawa
    • 1
  1. 1.Department of GastroenterologyAizu Medical Center, Fukushima Medical UniversityAizuwakamatsuJapan

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