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Endoscopic Management of Complications in Acute Pancreatitis

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ERCP and EUS

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Abstract

Common complications of acute pancreatitis include pancreatic duct leaks and pancreatic collections, which were recently reclassified into acute peripancreatic fluid collection, pseudocyst, acute necrotic collection, and walled-off pancreatic necrosis. Various endoscopic techniques can definitively treat many of these complications. Pancreatic leaks and fistulae are addressed with ERCP and placement of a transpapillary stent that bridges the site of a pancreatic duct disruption. Pseudocysts can be drained via cystgastrostomy with efficacy approaching 80 %. Furthermore, walled-off pancreatic necrosis can be managed via endoscopic necrosectomy with drainage and debridement resulting in a high degree of success and significant reduction in complications compared to surgery or radiologic drainage. The current chapter reviews the workup of these complications in acute pancreatitis and discusses the indications, timing, technique, outcomes, and complications of the endoscopic procedures employed to address these complications.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

    Wasif M. Abidi MD, PhD

  2. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

    Assoc. Prof. Christopher C. Thompson MD, MSc, FACG, FASGE

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  1. Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Linda S. Lee

Video Caption

Video Caption

Video 12. 1 The initial steps of endoscopic necrosectomy are similar to pseudocyst drainage. After giving the patient antibiotics, sedating under general anesthesia, and using carbon dioxide insufflation, the first step is identification and puncture of the wall of the WOPN. EUS is used to identify the location of the WOPN and confirm debris within the collection

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Abidi, W., Thompson, C. (2015). Endoscopic Management of Complications in Acute Pancreatitis. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_12

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