Skip to main content
SpringerLink
Log in

Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections

  • Chapter
  • First Online:
Book cover Interventional Endoscopic Ultrasound

  • 738 Accesses

Abstract

EUS-guided drainage of pancreatic fluid collections, including both pseudocysts and walled-off pancreatic necrosis, was once an uncommon procedure. The rise and widespread dissemination of interventional EUS techniques to perform drainage and debridement of these collections have made these procedures more appealing and much more widely performed and accepted. The advent and availability of lumen-apposing metal stents (LAMS) have also greatly facilitated these procedures, although other stent types can be used in a variety of settings. This chapter will review the current indications, techniques, and outcomes of patients undergoing EUS-guided drainage of pancreatic fluid collections. In addition, debridement techniques and adverse events of these procedures will be covered as well.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Baillie J. Pancreatic pseudocysts (part I). Gastrointest Endosc. 2004;59(7):873–9. Review.

    Article  Google Scholar 

  2. Brun A, Agarwal N, Pitchumoni CS. Fluid collections in and around the pancreas in acute pancreatitis. J Clin Gastroenterol. 2011;45(7):614–25.

    Article  Google Scholar 

  3. Pelaez-Luna M, Vege SS, Petersen BT, Chari ST, Clain JE, Levy MJ, Pearson RK, Topazian MD, Farnell MB, Kendrick ML, Baron TH. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc. 2008;68(1):91–7.

    Article  Google Scholar 

  4. 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(1):102–11.

    Article  Google Scholar 

  5. Morgan DE, Baron TH, Smith JK, Robbin ML, Kenney PJ. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology. 1997;203(3):773–8.

    Article  CAS  Google Scholar 

  6. Dhaka N, Samanta J, Kochhar S, Kalra N, Appasani S, Manrai M, Kochhar R. Pancreatic fluid collections: what is the ideal imaging technique? World J Gastroenterol. 2015;21(48):13403–10.

    Article  CAS  Google Scholar 

  7. Rana SS, Bhasin DK, Reddy YR, Sharma V, Rao C, Sharma RK, Gupta R. Morphological features of fluid collections on endoscopic ultrasound in acute necrotizing pancreatitis: do they change over time? Ann Gastroenterol. 2014;27(3):258–61.

    PubMed  PubMed Central  Google Scholar 

  8. Siddiqui AA, Adler DG, Nieto J, Shah JN, Binmoeller KF, Kane S, Yan L, Laique SN, Kowalski T, Loren DE, Taylor LJ, Munigala S, Bhat YM. EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos). Gastrointest Endosc. 2016;83(4):699–707.

    Article  Google Scholar 

  9. Adler DG, Siddiqui AA. What's in a name? Pancreatic pseudocysts, walled-off necrosis, and pancreatic fluid collections. Endosc Ultrasound. 2016;5(4):215–7.

    Article  Google Scholar 

  10. Seewald S, Ang TL, Kida M, Teng KY, Soehendra N, EUS 2008 Working Group. EUS 2008 Working Group document: evaluation of EUS-guided drainage of pancreatic-fluid collections (with video). Gastrointest Endosc. 2009;69(2 Suppl):S13–21.

    Article  Google Scholar 

  11. Teoh AY, Dhir V, Jin ZD, Kida M, Seo DW, Ho KY. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. World J Gastrointest Endosc. 2016;8(6):310–8.

    Article  Google Scholar 

  12. Ang TL, Teoh AYB. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig Endosc. 2017;29(4):463–71.

    Article  Google Scholar 

  13. Mangiavillano B, Pagano N, Baron TH, Arena M, Iabichino G, Consolo P, Opocher E, Luigiano C. Biliary and pancreatic stenting: devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography. World J Gastrointest Endosc. 2016;8(3):143–56.

    Article  Google Scholar 

  14. Wiersema MJ. Endosonography-guided cystoduodenostomy with a therapeutic ultrasound endoscope. Gastrointest Endosc. 1996;44(5):614–7.

    Article  CAS  Google Scholar 

  15. Giovannini M, Bernardini D, Seitz JF. Cystogastrotomy entirely performed under endosonography guidance for pancreatic pseudocyst: results in six patients. Gastrointest Endosc. 1998;48(2):200–3.

    Article  CAS  Google Scholar 

  16. Seifert H, Dietrich C, Schmitt T, Caspary W, Wehrmann T. Endoscopic ultrasound-guided one-step transmural drainage of cystic abdominal lesions with a large-channel echo endoscope. Endoscopy. 2000;32(3):255–9.

    Article  CAS  Google Scholar 

  17. Seicean A, Stan-Iuga R, Badea R, Tantau M, Mocan T, Seicean R, Iancu C, Pascu O. The safety of endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopic control: a single tertiary center experience. J Gastrointestin Liver Dis. 2011;20(1):39–45.

    PubMed  Google Scholar 

  18. Lin H, Zhan XB, Sun SY, Yang XJ, Jin ZD, Zou DW, Li ZS. Stent selection for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a multicenter study in China. Gastroenterol Res Pract. 2014;2014:193562.

    PubMed  PubMed Central  Google Scholar 

  19. Lopes CV, Pesenti C, Bories E, Caillol F, Giovannini M. Endoscopic ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts. Arq Gastroenterol. 2008;45(1):17–21.

    Article  Google Scholar 

  20. Antillon MR, Shah RJ, Stiegmann G, Chen YK. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc. 2006;63(6):797–803.

    Article  Google Scholar 

  21. Singhal S, Rotman SR, Gaidhane M, Kahaleh M. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc. 2013;46(5):506–14.

    Article  Google Scholar 

  22. Bang JY, Varadarajulu S. Metal versus plastic stent for transmural drainage of pancreatic fluid collections. Clin Endosc. 2013;46(5):500–2.

    Article  Google Scholar 

  23. Vazquez-Sequeiros E, Baron TH, Pérez-Miranda M, Sánchez-Yagüe A, Gornals J, Gonzalez-Huix F, de la Serna C, Gonzalez Martin JA, Gimeno-Garcia AZ, Marra-Lopez C, Castellot A, Alberca F, Fernandez-Urien I, Aparicio JR, Legaz ML, Sendino O, Loras C, Subtil JC, Nerin J, Perez-Carreras M, Diaz-Tasende J, Perez G, Repiso A, Vilella A, Dolz C, Alvarez A, Rodriguez S, Esteban JM, Juzgado D, Albillos A, Spanish Group for FCSEMS in Pancreas Collections. Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry. Gastrointest Endosc. 2016;84(3):450–457.e2.

    Article  Google Scholar 

  24. Varadarajulu S, Wilcox CM, Latif S, Phadnis M, Christein JD. Management of pancreatic fluid collections: a changing of the guard from surgery to endoscopy. Am Surg. 2011;77(12):1650–5.

    PubMed  Google Scholar 

  25. Siddiqui AA, Kowalski TE, Loren DE, Khalid A, Soomro A, Mazhar SM, Isby L, Kahaleh M, Karia K, Yoo J, Ofosu A, Ng B, Sharaiha RZ. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc. 2017;85(4):758–65.

    Article  Google Scholar 

  26. Adler DG. Drainage of a symptomatic pancreatic pseudocyst via a fully covered self expanding metal stent (FCSEMS). Pract Gastroenterol. 2014;4:26–30.

    Google Scholar 

  27. Berzosa M, Maheshwari S, Patel KK, Shaib YH. Single-step endoscopic ultrasonography-guided drainage of peripancreatic fluid collections with a single self-expandable metal stent and standard linear echoendoscope. Endoscopy. 2012;44(5):543–7.

    Article  CAS  Google Scholar 

  28. Weilert F, Binmoeller KF, Shah JN, Bhat YM, Kane S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy. 2012;44(8):780–3.

    Article  CAS  Google Scholar 

  29. Talreja JP, Shami VM, Ku J, Morris TD, Ellen K, Kahaleh M. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc. 2008;68(6):1199–203.

    Article  Google Scholar 

  30. Penn DE, Draganov PV, Wagh MS, Forsmark CE, Gupte AR, Chauhan SS. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc. 2012;76(3):679–84.

    Article  Google Scholar 

  31. Sharaiha RZ, DeFilippis EM, Kedia P, Gaidhane M, Boumitri C, Lim HW, Han E, Singh H, Ghumman SS, Kowalski T, Loren D, Kahaleh M, Siddiqui A. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc. 2015;82(5):822–7.

    Article  Google Scholar 

  32. Binmoeller KF, Shah J. A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy. 2011;43(4):337–42.

    Article  CAS  Google Scholar 

  33. Itoi T, Nageshwar Reddy D, Yasuda I. New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci. 2013;20(3):403–6.

    Article  Google Scholar 

  34. Moon JH, Choi HJ, Kim DC, Lee YN, Kim HK, Jeong SA, et al. A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos). Gastrointest Endosc. 2014;79(6):990–5.

    Article  Google Scholar 

  35. Baron TH, Harewood GC, Morgan DE, Yates MR. Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts. Gastrointest Endosc. 2002;56(1):7–17.

    Article  Google Scholar 

  36. Lee HS, Chung MJ. Past, present, and future of gastrointestinal stents: new endoscopic ultrasonography-guided metal stents and future developments. Clin Endosc. 2016;49(2):131–8.

    Article  Google Scholar 

  37. McVay T, Adler DG. EUS-guided drainage of pancreatic fluid collections: double pigtails, metal biliary, or dedicated transluminal stents? Endosc Ultrasound. 2015;4(1):1–3.

    Article  Google Scholar 

  38. Bang JY, Hasan MK, Navaneethan U, Sutton B, Frandah W, Siddique S, et al. Lumen apposing metal stents (LAMS) for drainage of pancreatic fluid collections: when and for whom? Dig Endosc. 2017;29:83.

    Article  Google Scholar 

  39. Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc. 2008;68(4):656–66.

    Article  Google Scholar 

  40. Bang JY, Hawes R, Bartolucci A, Varadarajulu S. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review. Dig Endosc. 2015;27(4):486–98.

    Article  Google Scholar 

  41. Lang GD, Fritz C, Bhat T, Das KK, Murad FM, Early DS, Edmundowicz SA, Kushnir VM, Mullady DK. EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates. Gastrointest Endosc. 2018;87:150.

    Article  Google Scholar 

  42. Ang TL, Kongkam P, Kwek AB, Orkoonsawat P, Rerknimitr R, Fock KM. A two-center comparative study of plastic and lumen-apposing large diameter self-expandable metallic stents in endoscopic ultrasound-guided drainage of pancreatic fluid collections. Endosc Ultrasound. 2016;5(5):320–7.

    Article  Google Scholar 

  43. Bang JY, Hasan MK, Navaneethan U, Sutton B, Frandah W, Siddique S, Hawes RH, Varadarajulu S. Lumen-apposing metal stents for drainage of pancreatic fluid collections: when and for whom? Dig Endosc. 2017;29(1):83–90.

    Article  Google Scholar 

  44. Yoo J, Yan L, Hasan R, Somalya S, Nieto J, Siddiqui AA. Feasibility, safety, and outcomes of a single-step endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopy using a novel electrocautery-enhanced lumen-apposing, self-expanding metal stent. Endosc Ultrasound. 2017;6(2):131–5.

    Article  Google Scholar 

  45. Rinninella E, Kunda R, Dollhopf M, Sanchez-Yague A, Will U, Tarantino I, Gornals Soler J, Ullrich S, Meining A, Esteban JM, Enz T, Vanbiervliet G, Vleggaar F, Attili F, Larghi A. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc. 2015;82(6):1039–46.

    Article  Google Scholar 

  46. Adler DG, Taylor LJ, Hasan R, Siddiqui AA. A retrospective study evaluating endoscopic ultrasound-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery enhanced delivery system. Endosc Ultrasound. 2017;6(6):389–93. https://doi.org/10.4103/eus.eus_4_17.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Bang JY, Hasan M, Navaneethan U, Hawes R, Varadarajulu S. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut. 2017;66:2054.

    Article  Google Scholar 

  48. Walter D, Will U, Sanchez-Yague A, Brenke D, Hampe J, Wollny H, López-Jamar JM, Jechart G, Vilmann P, Gornals JB, Ullrich S, Fähndrich M, de Tejada AH, Junquera F, Gonzalez-Huix F, Siersema PD, Vleggaar FP. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study. Endoscopy. 2015;47(1):63–7.

    PubMed  Google Scholar 

  49. Chandran S, Efthymiou M, Kaffes A, Chen JW, Kwan V, Murray M, Williams D, Nguyen NQ, Tam W, Welch C, Chong A, Gupta S, Devereaux B, Tagkalidis P, Parker F, Vaughan R. Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endosc. 2015;81(1):127–35.

    Article  Google Scholar 

  50. Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J, Siddiqui UD, Waxman I, Joshi V, Benias PC, Darwin P, DiMaio CJ, Mulder CJ, Friedland S, Forcione DG, Sejpal DV, Gonda TA, Gress FG, Gaidhane M, Koons A, DeFilippis EM, Salgado S, Weaver KR, Poneros JM, Sethi A, Ho S, Kumbhari V, Singh VK, Tieu AH, Para V, Likhitsup A, Womeldorph C, Casey B, Jonnalagadda SS, Desai AP, Carr-Locke DL, Kahaleh M, Siddiqui AA. Endoscopic therapy with lumen-apposing metal stents is safe and effective for patients with pancreatic walled-off necrosis. Clin Gastroenterol Hepatol. 2016;14:1797.

    Article  Google Scholar 

  51. Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG, Dutch Acute Pancreatitis Study Group. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009;96(3):267–73.

    Article  CAS  Google Scholar 

  52. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG, Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491–502.

    Article  Google Scholar 

  53. Guo J, Feng L, Sun S, Ge N, Liu X, Wang S, Wang G, Sun B. Risk factors for infection after endoscopic ultrasonography-guided drainage of specific types of pancreatic and peripancreatic fluid collections (with video). Surg Endosc. 2016;30(7):3114–20.

    Article  Google Scholar 

  54. Eliason K, Adler DG. Endoscopic ultrasound-guided transmural drainage of infected pancreatic necrosis developing 2 years after acute pancreatitis. Endosc Ultrasound. 2015;4(3):260–5.

    Article  Google Scholar 

  55. Kahaleh M, Shami VM, Conaway MR, Tokar J, Rockoff T, De La Rue SA, de Lange E, Bassignani M, Gay S, Adams RB, Yeaton P. Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy. 2006;38(4):355–9.

    Article  CAS  Google Scholar 

  56. Ahlawat SK, Charabaty-Pishvaian A, Jackson PG, Haddad NG. Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients. JOP. 2006;7(6):616–24.

    PubMed  Google Scholar 

  57. Itoi T, Binmoeller KF, Shah J, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Moriyasu F. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc. 2012;75(4):870–6.

    Article  Google Scholar 

  58. Shah RJ, Shah JN, Waxman I, Kowalski TE, Sanchez-Yague A, Nieto J, Brauer BC, Gaidhane M, Kahaleh M. 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(4):747–52.

    Article  Google Scholar 

  59. Bapaye A, Itoi T, Kongkam P, Dubale N, Mukai S. 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(4):499–504.

    Article  Google Scholar 

  60. Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol. 2011;26(10):1504–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Jeffrey S. Bank & Douglas G. Adler

Authors
  1. Jeffrey S. Bank
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Douglas G. Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas G. Adler .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Douglas G. Adler, MD, FACG, AGAF, FASGE

Electronic Supplementary Material

EUS-guided drainage of a PFC using a LAMS (MP4 125126 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bank, J.S., Adler, D.G. (2019). Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections. In: Adler, MD, FACG, AGAF, FASGE, D. (eds) Interventional Endoscopic Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-97376-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97376-0_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97375-3

  • Online ISBN: 978-3-319-97376-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation