Role of Endoscopy in the Diagnosis and Treatment of Inflammatory Pancreatic Fluid Collections

Publication Date: March 2, 2016
Last Updated: March 14, 2022

Summary

We recommend that endoscopic drainage of PFCs be performed only after sufficient exclusion of alternative diagnoses, such as cystic pancreatic neoplasms and pseudoaneurysms. (⊕⊕⊕⊕)
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We recommend waiting for maturation of the cyst wall of PFCs before endoscopic intervention. (⊕⊕⊕o)
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We recommend drainage of symptomatic pancreatic pseudocysts. (⊕⊕⊕o)
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We suggest drainage of rapidly enlarging pancreatic pseudocysts. (⊕⊕oo)
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We recommend drainage of all infected PFCs in patients who fail to improve with conservative management alone. (⊕⊕⊕⊕)
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We recommend drainage of symptomatic sterile necrosis lasting more than 8 weeks after the onset of acute pancreatitis. (⊕⊕⊕o)
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We suggest that routine FNA of PFCs is not required to diagnose infected necrosis. (⊕⊕oo)
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We recommend that endoscopic drainage be considered for initial therapy before surgical drainage of pancreatic pseudocysts. (⊕⊕⊕o)
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We recommend using EUS for transmural drainage of PFCs in the absence of a luminal bulge or when portal hypertension is suspected. (⊕⊕⊕⊕)
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We recommend initial endoscopic transmural and/or percutaneous drainage of WON before consideration of endoscopic transmural necrosectomy or surgical drainage. (⊕⊕⊕o)
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We recommend that endoscopic drainage of PFCs be performed only with the availability of surgical and interventional radiology support. (⊕⊕⊕⊕)
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We suggest using CO2 when performing transmural drainage procedures. (⊕⊕oo)
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Recommendation Grading

Overview

Title

Role of Endoscopy in the Diagnosis and Treatment of Inflammatory Pancreatic Fluid Collections

Authoring Organization

American Society for Gastrointestinal Endoscopy

Publication Month/Year

March 2, 2016

Last Updated Month/Year

January 19, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This guideline supplements and replaces our previous document on the role of endoscopy in the diagnosis and management of cystic lesions and inflammatory fluid collections of the pancreas

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Medical assistant, laboratory technician, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D010181 - Pancreatic Cyst, D010182 - Pancreatic Diseases

Keywords

inflammation, endoscopy, pancreatic fluid collections

Source Citation

Muthusamy, V. R., Chandrasekhara, V., Acosta, R. D., Bruining, D. H., Chathadi, K. V., Eloubeidi, M. A., … DeWitt, J. M. (2016). The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointestinal Endoscopy, 83(3), 481–488. doi:10.1016/j.gie.2015.11.027 

Methodology

Number of Source Documents
135
Literature Search Start Date
January 2, 1990
Literature Search End Date
February 2, 2015