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

Video Transcription

Video Summary

Dr. Shyam Varadarajulu, President of the Digestive Health Institute at Orlando Health, spoke about the endoscopic management of acute pancreatitis in a video presentation. He emphasized that endoscopy is not used in the treatment of acute pancreatitis but is focused on managing complications. Dr. Varadarajulu highlighted that endoscopy is preferred over surgical and radiological approaches due to its high success rate of over 90%. He discussed various strategies to manage outcomes in necrotizing pancreatitis, including decreasing the number of interventions, tailoring treatment to each patient, and performing early necrosectomy when necessary. He also emphasized the importance of standardized follow-up and addressing recurrence by managing ductal problems. Dr. Varadarajulu provided practical tips for stent placement, showing the use of balloon dilation to gain access to necrotic collections and the importance of placing stents in the distal part of the stomach for better access during necrosectomy. He also discussed the importance of irrigation and careful consideration of stent placement based on the characteristics of fluid collections. Dr. Varadarajulu mentioned the use of percutaneous drainage when necessary but highlighted the potential disadvantages, including higher mortality, longer hospitalization, and increased costs compared to endoscopic drainage. He stressed the need for proper triage of patients and education of hospitalists and general surgeons on the benefits of endoscopic drainage. The presentation concluded with a discussion on the timing of interventions, the importance of early enteral nutrition, and ongoing research on the optimal approach to necrosectomy. Dr. Varadarajulu highlighted the importance of following a protocol for the management of patients with fluid collections and provided data on the success rates and outcomes of his approach. The presentation also touched on the management of recurrent fluid collections, with a focus on addressing ductal problems and performing interventions as needed. Dr. Varadarajulu urged the audience to read a relevant manuscript for further information on managing these patients effectively.

Asset Subtitle

Shyam S. Varadarajulu, MD

Keywords

endoscopic management

acute pancreatitis

complications

necrotizing pancreatitis

stent placement

endoscopic drainage