ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-11 Varadarajulu_Endoscopic Management of Acute Pancreatitis

11 Varadarajulu_Endoscopic Management of Acute Pancreatitis

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The document discusses the endoscopic management of acute pancreatitis, highlighting the advantages of endoscopy over surgical or radiological approaches. The success rate of endoscopic treatment is over 90%, although there are higher rates of reinterventions, length of stay, rehospitalization, and costs when treating necrotic collections. The placement of lumen-apposing metal stents (LAMS) is preferable to plastic stents.<br /><br />The future perspective should focus on addressing the limitations of current approaches, including reinterventions, length of stay, nutrition, percutaneous drainage, adverse events, and standardization of follow-up. The selection and placement of LAMS are crucial, with specific criteria for size limitations and location to ensure optimal drainage and avoid complications.<br /><br />Necrosectomy is recommended for patients with symptoms of sepsis, SIRS, organ failure, and poor drainage of cyst contents and necrotic debris. Timing of necrosectomy should be based on the index procedure and the persistence of symptoms and decrease in necrosis on reimaging at 72 hours.<br /><br />Enteral nutrition is recommended for severe acute pancreatitis, while percutaneous drainage is suggested for endoscopically inaccessible symptomatic pancreatic fluid collections (PFCs) with necrotic debris or >35% necrosis. Standardized follow-up is essential to monitor clinical and radiological improvement and reduce reinterventions.<br /><br />Disconnected pancreatic ducts and pancreatic duct leaks are associated with increased rates of PFC recurrence. Treatment options include draining disconnected pancreatic ducts and decompressing obstructed ducts.<br /><br />The document also mentions ongoing research, such as the DESTIN trial comparing direct endoscopic vs. step-up transluminal interventions in necrotizing pancreatitis.<br /><br />Overall, the successful management of acute pancreatitis depends on effectively managing necrotic collections and considering individualized treatment approaches.

Keywords

endoscopic management

acute pancreatitis

advantages of endoscopy

reinterventions

necrosectomy

percutaneous drainage

standardization of follow-up

pancreatic fluid collections

treatment options

DESTIN trial