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• W4385562863 abstract "Pancreatic fluid collections (PFC) persisting beyond 4 weeks after an attack of acute pancreatitis (AP) can be classified as either walled-off pancreatic necrosis (WOPN) involving both pancreatic and/or peripancreatic tissue or pancreatic pseudocysts by the revised Atlanta classification. Pancreatic pseudocysts are defined as free of solid debris and are considered a rare event after AP and are often associated with a disconnected pancreatic duct. Only collections that cause symptoms or are at high risk for severe complications require intervention. Treating a PFC endoscopically is considered safe once a well-defined wall has developed. Immediate drainage of infected fluid collections is not superior to a delayed approach with adequate antibiotic treatment at first, and 39% to 80% resolve without intervention. It is currently impossible to predict which collections will resolve spontaneously or with conservative treatment, which require drainage and irrigation, and in which cases endoscopic necrosectomy is needed. Transmural endoscopic treatment of WOPN is equally safe and effective when compared to minimally invasive surgical approaches, but appears to be more cost-effective and leads less often to pancreatic fistulas. Self-expandable lumen-apposing metal stents, which allow efficient endoscopic drainage as well as necrosectomy through the same access route and can be deployed through the echoendoscope, have replaced the use of conventional double-pigtail stents, but come at a higher risk of delayed bleeding and should be used in experienced hands only. Recurrence or persistence of PFC is often associated with a disconnected pancreatic duct. If suspected, the integrity of the pancreatic duct should be confirmed by noninvasive methods such as magnetic resonance cholangiopancreatography. Regarding treatment of disconnected pancreatic duct syndrome, endoscopic or surgical approaches are viable options, but should only be performed at expert centers. Due to the lack of prospective data, the optimal treatment strategy of disconnected duct syndrome is still unknown." @default.
• W4385562863 created "2023-08-04" @default.
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• W4385562863 date "2023-08-04" @default.
• W4385562863 modified "2023-09-27" @default.
• W4385562863 title "Strategies for the Treatment of Pancreatic Pseudocysts and Walled‐Off Necrosis After Acute Pancreatitis" @default.
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• W4385562863 doi "https://doi.org/10.1002/9781119876007.ch33" @default.
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