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

11 Varadarajulu_Endoscopic Management of Acute Pancreatitis

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Endoscopic management of acute pancreatitis is a preferred approach over surgical or radiological methods, with a treatment success rate of over 90%. However, there are limitations that need to be addressed to improve outcomes. Reinterventions, length of stay, rehospitalization, and costs are higher when treating necrotic collections. The placement of lumen-apposing metal stents (LAMS) is preferred over plastic stents. Selection and placement of LAMS should consider the size and location of the pancreatic fluid collection (PFC). Irrigation is a key aspect of stent management. Necrosectomy may be necessary for patients with symptoms of sepsis, organ failure, or failure to thrive, as well as for those with poor drainage of cyst contents and necrotic debris. The timing of necrosectomy depends on the percentage of necrosis and the persistence of symptoms. Enteral nutrition is recommended for severe acute pancreatitis, while percutaneous drainage is used for endoscopically inaccessible symptomatic PFCs. Standardized follow-up reduces the need for reinterventions and reduces length of stay. The research agenda includes comparing direct endoscopic interventions with step-up transluminal interventions. Disconnected pancreatic ducts and obstruction or leaks require specific treatment approaches. Overall, the success of endoscopic management depends on the effective management of necrotic collections.

Keywords

endoscopic management

acute pancreatitis

treatment success rate

necrotic collections

LAMS

pancreatic fluid collection

necrosectomy

severe acute pancreatitis

percutaneous drainage

specific treatment approaches