Advanced Endoscopy Fellows Program | September 2022-Rustagi

Rustagi_Recurrent Pancreatic Fluid Collection

Pdf Summary

This document discusses recurrent pancreatic fluid collections (PFC) in a case study. The patient in the case study is a 45-year-old male who experienced his first episode of acute gallstone pancreatitis 4.5 months ago. A CT scan taken 5 weeks after the pancreatitis showed a large 10 cm perigastric PFC, which was treated with an endoscopic ultrasound-guided cystgastrostomy with a covered metal stent (CE-LAMS). The LAMS was removed after 3 weeks, and the PFC completely resolved. However, a repeat CT scan conducted for abdominal discomfort and early satiety revealed recurrent PFC.<br /><br />The document also mentions the findings of a study that included 274 patients with walled-off necrosis (WON) who underwent treatment with CE-LAMS. In this study, 93% of the patients underwent ERCP prior to LAMS removal, and 74% had distal pancreatic duct (DPD) disruption. The study found that 13% of the patients developed recurrent PFC at a median follow-up of 5 months. Furthermore, the majority (97%) of these cases had DPD disruption.<br /><br />Based on this information, the author suggests a management approach for recurrent PFC. The approach includes using CE-LAMS for the initial episode of PFC, not routinely performing ERCP to evaluate for DPD unless there are specific indications, removing the LAMS after PFC resolution, and conducting follow-up MRI/MRCP only if symptoms recur. For cases of recurrent PFC in the absence of recurrent acute pancreatitis (RAP), the author recommends performing dual-phase secretin-enhanced MRI/MRCP and possible ERCP.<br /><br />In conclusion, this document provides insights into recurrent pancreatic fluid collections and offers a suggested management approach for such cases.

Keywords

recurrent pancreatic fluid collections

PFC

case study

acute gallstone pancreatitis

CT scan

CE-LAMS

recurring PFC

ERCP

DPD disruption

management approach