Endoscopic treatment of pancreatic fluid collections in 2008 and beyond

摘要

INTRODUCTIONPancreatic-fluid collections may occur as a result of acute or chronic pancreatitis, surgery, trauma, or neopla-sia. With the exception of cystic neoplasia, collections form as a consequence of either a disruption of the pancreatic duct, with subsequent fluid leakage, or maturation of peripancreatic necrosis. Indications for drainage of these collections consist of pain, gastric outlet obstruction, obstruction of the biliary tract, and infection. Therapeutic options include surgery, endoscopy, and/or percutaneous drainage. There are no randomized trials that compare any of these approaches. Surgery, which has been the criterion standard for decades, is associated with significant morbidity and mortality rates.1'2'4'6 Percutaneous drainage is attractive in that it appears to be the least invasive, but it does require the patient to have an external drain for an extended period of time and is associated with a significant rate of percutaneous fistulas. Since the first reports of endoscopic drainage of pancreatic-fluid collections in the early 1980s, experience was widely gained, with compelling results. This article reviews the current status and the future of endoscopic treatment of pancreatic-fluid collections.