Endoscopic management of pancreatic walled-off necrosis

Daryl Ramai; Amanda D. Morgan; Paraskevas Gkolfakis; Antonio Facciorusso; Saurabh Chandan; Apostolis Papaefthymiou; John Morris; Marianna Arvanitakis; Douglas G. Adler

Authors Daryl Ramai, Amanda D. Morgan, Paraskevas Gkolfakis, Antonio Facciorusso, Saurabh Chandan, Apostolis Papaefthymiou, John Morris, Marianna Arvanitakis, Douglas G. Adler.

Abstract

Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.

Keywords Pancreatitis, walled-off necrosis, pancreatic fluid collection, endoscopic transmural drainage, stent

Ann Gastroenterol 2023; 36 (2): 123-131