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Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future perspectives

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Abstract

Pancreatic fluid collections (PFCs) commonly develop as complications of acute pancreatitis and ductal disruption due to chronic pancreatitis. In the revised Atlanta classification, PFCs were classified based on the presence of necrosis and duration following the onset of acute pancreatitis. Interventions are required in cases of symptomatic pancreatic pseudocysts or walled-off necrosis (WON). In the management of these PFCs, endoscopic ultrasound-guided transluminal drainage and subsequent direct endoscopic necrosectomy for WON are increasingly utilized as less invasive treatment modalities compared to surgical debridement. To date, researchers have focused predominantly on the technical aspects of endoscopic therapy for symptomatic PFCs. Given the poor physical condition of patients receiving endoscopic treatment for PFCs, systemic support may have a substantial impact on the short- and long-term outcomes of these patients. A multidisciplinary approach is required to improve the clinical outcomes of patients with infected PFCs and their associated comorbidities. However, non-interventional support during the periprocedural period of endoscopic treatment of PFCs has not been fully discussed, and there have been considerable variations in the selection of treatment options between endoscopists and centers. To address these unmet needs in the clinical management of PFCs and promote future research to improve the clinical outcomes, we conducted a review of the literature within a multicenter consortium of expert endoscopists with specific expertise in the endoscopic treatment of PFCs. In this review, we summarize the current evidence on non-interventional supportive care (e.g., continuous lavage, medications, nutritional support, and antimicrobials) and propose potential topics for future research.

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Data availability

The data used in the current study will be available from the corresponding author on reasonable request.

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Acknowledgements

We would like to appreciate the following members of the WONDERFUL study group for their valuable comments on the manuscript: Ryuichi Tezuka, Senju Akihiko, First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan; Mitsuru Okuno, Yuhei Iwasa, Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan; Tatsuya Sato, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Ryota Nakano, Shogo Ota, Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan; Shunsuke Omoto, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan; Kensaku Yoshida, Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan; Arata Sakai, Masahiro Tsujimae, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Keito Nakagawa, Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan; and Toshio Fujisawa, Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

Funding

This work was supported in part by a grant from the Japanese Foundation for Research and Promotion of Endoscopy (#1015 to T.S.). T.H. was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI grants (JP19K08362 and JP22H02841) and a grant from Takeda Science Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Takuji Iwashita and Keisuke Iwata contributed equally as co-first authors.

  2. Ichiro Yasuda and Yousuke Nakai contributed equally as co-last authors.

Authors and Affiliations

  1. First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

    Takuji Iwashita & Shinya Uemura

  2. Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan

    Keisuke Iwata

  3. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Tsuyoshi Hamada, Tomotaka Saito & Yousuke Nakai

  4. Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Tsuyoshi Hamada

  5. Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan

    Hideyuki Shiomi

  6. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan

    Mamoru Takenaka

  7. Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan

    Akinori Maruta

  8. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan

    Atsuhiro Masuda

  9. Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan

    Saburo Matsubara

  10. Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan

    Tsuyoshi Mukai

  11. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Sho Takahashi & Hiroyuki Isayama

  12. Third Department of Internal Medicine, University of Toyama, Toyama, Japan

    Nobuhiko Hayashi & Ichiro Yasuda

  13. Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan

    Yousuke Nakai

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  1. Takuji Iwashita
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Contributions

TI, KI, and TH: conception of the work, search of the literature, interpretation of the data, and drafting of the article. TS, HS, MT, AM, SU, AM, SM, ST, NH, TM, and HI: critical revision of the article for important intellectual content. IY and YN: critical revision of the article for important intellectual content and supervision of the work.

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Correspondence to Takuji Iwashita.

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Conflicts of interest

YN received research grants from Boston Scientific Japan and HOYA Corporation, and honoraria from Boston Scientific Japan, Fujifilm Corporation, and Olympus Corporation. HI received research grants from Boston Scientific Japan, Fujifilm Corporation, Fujifilm Health Care Corporation, Gaderius Medical KK, and Zeon Medical Inc., and honoraria from Boston Scientific Japan, Fujifilm Corporation, Taewoong Medical Devices, Olympus Corporation, Century Medical Inc., and Cook Medical Japan G.K. The other authors did not have any conflicts of interest related to this article.

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Iwashita, T., Iwata, K., Hamada, T. et al. Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future perspectives. J Gastroenterol 58, 98–111 (2023). https://doi.org/10.1007/s00535-022-01935-y

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