Interventional Endoscopic Ultrasound (EUS) | October 2026-Tiellman_ASGE Interventional EUS Pancreas Collections

Tiellman_ASGE Interventional EUS Pancreas Collections

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The presentation reviews endoscopic management of pancreatic fluid collections as an accessible starting point for interventional EUS. These collections are often large, close to the stomach, and relatively immobile, making them useful for developing procedural skills.<br /><br />Drainage should be avoided when a collection is not closely apposed to the gastrointestinal tract, is too immature and lacks an encapsulating wall, or presents excessive bleeding risk—such as nearby large vessels, pseudoaneurysm, active bleeding, or coagulopathy. Potential adverse events include bleeding or vessel injury, stent erosion or maldeployment, perforation, infection from incomplete drainage, and migration.<br /><br />Lumen-apposing metal stents (LAMS) simplify transmural drainage and provide access for draining walled-off necrosis (WON) and performing endoscopic necrosectomy. Deployment requires controlled catheter advancement and staged release of the distal and proximal flanges, with careful attention to catheter position and visualization.<br /><br />Double-pigtail plastic stents remain an option, particularly for smaller collections or pseudocysts. Compared with LAMS, they are less expensive, may carry lower bleeding risk, and can be left in place long term. However, they provide less convenient access for necrosectomy, and distinguishing WON from a pseudocyst may not always be straightforward. Placement may involve a needle, guidewire, optional cystotome, dilation tools, and one or more stents.<br /><br />Necrosectomy can use snares, graspers, or nets. LAMS may be removed and replaced during the procedure; hydrogen peroxide may be used when necrosis remains. The presentation also advises avoiding proton-pump inhibitors and mentions Diet Coke.<br /><br />Overall, endoscopic treatment is a first-line mainstay for pancreatic collections. Experience with their drainage and necrosectomy can help build a broader interventional EUS practice.

Keywords

pancreatic fluid collections

interventional EUS

endoscopic drainage

walled-off necrosis

lumen-apposing metal stents

double-pigtail plastic stents

endoscopic necrosectomy

pseudoaneurysm risk

transmural drainage

pancreatic pseudocyst