ENDOSCOPIC ULTRASOUND FEATURES OF PANCREATIC FLUID COLLECTIONS AND THEIR IMPACT ON THERAPEUTIC DECISIONS: AN INTEROBSERVER AGREEMENT STUDY

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Fabbri ◽  
Todd Baron ◽  
Giulia Gibiino ◽  
Paolo Giorgio Arcidiacono ◽  
Cecilia Binda ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Interobserver Agreement ◽  
Morphological Characteristics ◽  
Solid Component ◽  
Therapeutic Approaches ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Therapeutic Decisions ◽  
Fluid Collections ◽  
Agreement Study

Background and study aims: A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS related PFCs features and therapeutic approaches utilized. Patients and methods: Fifty EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage of solid component, presence of infection, recognition and communication of the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet’s AC1 coefficient was used to assess interobserver agreement. Results: A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage of solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75). Conclusions: Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted.

scholarly journals Endoscopic Management of Pancreatic Fluid Collections

2021 ◽  
Vol 10 (2) ◽  
pp. 284
Author(s):  
Robert Dorrell ◽  
Swati Pawa ◽  
Rishi Pawa
Keyword(s):  
Patient Outcomes ◽  
Endoscopic Management ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Endoscopic Intervention ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Transmural Drainage ◽  
Fluid Collections

Pancreatic fluid collections (PFCs) are a common sequela of pancreatitis. Most PFCs can be managed conservatively, but symptomatic PFCs require either surgical, percutaneous, or endoscopic intervention. Recent advances in the therapeutics of PFCs, including the step-up approach, endoscopic ultrasound-guided transmural drainage with lumen apposing metal stents, and direct endoscopic necrosectomy, have ushered endoscopy to the forefront of PFCs management and have allowed for improved patient outcomes and decreased morbidity. In this review, we explore the progress and future of endoscopic management of PFCs.

Managing adverse events after endoscopic ultrasound‐guided (EUS) drainage of the biliary tract and pancreatic fluid collections: a narrative review (with video)

2021 ◽  
Author(s):  
Mateus Pereira Funari ◽  
Igor Braga Ribeiro ◽  
Marcos Eduardo Lera dos Santos ◽  
Sergio Eiji Matuguma ◽  
Eduardo Guimarães Hourneaux de Moura
Keyword(s):  
Adverse Events ◽  
Biliary Tract ◽  
Endoscopic Ultrasound ◽  
Narrative Review ◽  
Ultrasound Guided ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Fluid Collections

Drenaje guiado por ultrasonido endoscópico con stent metálico de aposición luminal y necrosectomía endoscópica directa para el tratamiento de la necrosis pancreática infectada

2020 ◽  
Vol 50 (2) ◽  
Keyword(s):  
Pancreatic Necrosis ◽  
Tube Feeding ◽  
Safe Procedure ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid ◽  
Nasojejunal Tube ◽  
Fluid Collections ◽  
Walled Off Necrosis ◽  
First Time

Walled-off necrosis (WON) is a serious complication of acute pancreatitis (AP) and, when is infected, has a poor prognosis and mortality rate (15%). The endoscopic approach is preferable to surgical treatment due to its lower morbidity. Objectives. 1) Present a patient with infected pancreatic necrosis resolved by Endoscopic Ultrasound (EUS) guided drainage with a luminal apposition metal stent (LAMS) and Direct Endoscopic Necrosectomy (DEN). 2) Report placement of the LAMS Hot Axios ® (Boston Scientific) for the first time ever in Argentina. Methods. Male, 38 years old, without relevant history. He is hospitalized for a severe acute biliary pancreatitis (AP), early satiety and digestive intolerance. At 4 weeks, CT scan shows a PFC of 16 cm. EUS-guided drainage was performed with LAMS Hot Axios ®, draining 1600 ml of brown liquid content. Ten days later, another episode of severe AP. Continuous fever. New CT and EUS, showed increased collection, in situ stent and necrosis inside (WON). Four sessions of DEN through-the-LAMS and laparoscopic cholecystectomy were performed. Percutaneous drainage of left pararenal necrosis. Nasojejunal tube feeding between each necrosectomy. At 8th week, absence of necrosis and granulation tissue was observed, then the LAMS was removed. Hospital discharge. After 6 months of follow up, CT control showed normal pancreatic parenchyma. Conclusions. EUS-guided drainage of Pancreatic fluid collections (PFC) with LAMS is a safe procedure. In cases of WON, LAMS also allows transluminal interventional procedures, expediting the treatment of pancreatic necrosis, in a minimally invasive way.

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