Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.
Endosonography ; Mortality ; Necrosis ; Pancreatitis ; Stents ; Ultrasonography

An isolated pyogenic pancreatic abscess (IPPA) without pancreatitis is extremely rare but can occur in patients with uncontrolled diabetes. This pathologic condition poses a clinical challenge in diagnosis and management because it can be confused easily with a malignancy. Endoscopic ultrasound (EUS) may be a useful diagnostic modality for indeterminate pancreatic lesions and IPPA. Here, we report two cases with elevated carbohydrate antigen 19-9 levels and pancreatic masses on cross sectional imaging. The patients were subsequently diagnosed with IPPA by EUS. EUS-guided drainage was performed successfully and the patients' clinical symptoms and radiologic findings improved. In our experience, EUS and EUS-guided drainage are crucial steps for the diagnosis and management of patients with an indeterminate pancreatic lesion. In addition, EUS-guided drainage has excellent technical and clinical outcomes for the treatment of IPPA.
Abscess* ; Diagnosis ; Drainage* ; Humans ; Pancreas ; Pancreatitis ; Ultrasonography

A retrospective analysis of ultrasonograms of 24 patients with acute pancreatitis and 8 patients with chronicpancreatitis was performed. Nine cases were proven by surgery and 23 cases were diagnosed clinically. Generalizedpancreatic enlargement with normal in size and echogenicity was normal or slightly altered in chronicpancreatitis. Ultrasonography is considered a simple and accurate method in the diagnosis of acute pancreatitisand thus it could be an initial test in patients with suspected acute pancreatitis.
Diagnosis ; Humans ; Methods ; Pancreatitis ; Retrospective Studies ; Ultrasonography

Chronic pancreatitis is an irreversible inflammatory disease of the pancreas characterized by progressive inflammation and fibrosis resulting in loss of exocrine and endocrine function. Chronic pancreatitis is a wide spectrum of fibro-inflammatory disorders of the pancreas that includes calcifying, obstructive, and steroid-responsive form. Chronic pancreatitis without specific comment generally refers to calcifying or obstructive chronic pancreatitis. The well-known traditional causes of chronic pancreatitis are alcohol and smoking. Recently, environmental effects and the importance of genes such as genetic variation or interaction have been highlighted. Computerized tomography or magnetic resonance cholangiopancreatography have been used for diagnosis of chronic pancreatitis. However, endoscopic ultrasound has been recently used for diagnosis, too.
Cholangiopancreatography, Magnetic Resonance ; Diagnosis* ; Fibrosis ; Genetic Variation ; Inflammation ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Smoke ; Smoking ; Ultrasonography

A retrospective comparative analysis was made to assess the relative efficacy and advantage of computedtomograhy (CT) and ultrasound in the diagnosis of pancreatic lesions in patients wtih 33 various pancreaticdiseases. All patients underwent both CT and ultrasound examinations. CT has advantages in delineation ofmorphologic anatomy and its extent, and in identifying abnormal gas and calcification. On the other hand,ultrasound has advantages in evaluation of cystic lesion, pancreatic duct and bile duct. Authors recommendultrasound as a screeing test in the diagnosis of uncomplicated pancreatic duct and bile duct. Authors recommendultrasound as a screening test in the diagnosis of uncomplicated pancreatitis, pseudocyst and pancreatic cancerproducing jaundice, but recommend CT in the diagnosis of complicated pancreatitis, chronic pancreatitis andnon-jaundiced patient with susupected pancereatic cancer. Ultrasound has additional advantage in ultrasound-guidedaspiration biopsy.
Bile Ducts ; Biopsy ; Diagnosis ; Humans ; Jaundice ; Mass Screening ; Pancreatic Ducts ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies ; Ultrasonography

The study was performed on 41 patients using concurrently ultrasound and CT scanner. They were diagnosed surgically and by blood amylase quantified 3 fold higher than normal subjects. Kappa’s indicators were applied for evaluating the concord between ultrasound and CT scanned images. Results showed that both methods of diagnosis were effective for identification and monitoring acute inflammation of the pancrea. In the prognosis, CT scanning is great advantage, especially in necrosis of the parenchyme. Both were limited on the detection of hemorrhagic form of micronecrosis.
Diagnosis ; pancreatitis ; ultrasonography ; Tomography Scanners, X-Ray Computed

From Jan 1998 to Dec 2000 a study on 41 acute pancreatitis patients was conducted by comparation description with ultrasound and CT scanning. The diagnostic results of two techniques are coincident considerably such as the large dimension of pancrea, the infiltration of the tissues around the pancrea, the gangrene of parenchyma. However, CT is preferable to ultrasound in the prognosis, these two techniques were suitable in diagnosis of acute pancreatitis, ultrasound can be used as a detective tool for discovering preliminarily acute pancreatitis and afterwards, CT can conducted to evaluate the prognosis. These techniques can let pass the dispensed hemorrlagy and the gangrene of parenchyma
Pancreatitis, Acute Necrotizing ; ultrasonography ; Patients ; Tomography, Emission-Computed

A large symptomatic and unresolved pancreatic pseudocyst is treated surgically by internal drainage to a neighboring adherent viscus. Recently the various minimal invasive approaches have been used to treat this condition. A 30- year-old man who had been in clinical follow-up for a chronic pancreatitis. For the necrotizing pancreatitis, the patient had undergone surgical debridement and external drainage 5 years, and 3 years ago, respectively. Abdominal ultrasonography and computed tomography revealed 8.2x7.7 cm sized pseudocyst in the body of pancreas. Endoscopic internal fistula formation was tried, but it was failed due to bleeding. We underwent adhesiotomy and cystogastrostomy totally with laparoscopic techniques. The patient started a diet on the 5th postoperative day and discharged on the 11th postoperative day. There was no postoperative complicationand no recurrence during 6 months. Laparoscopic cystogastrostomy is safe and feasible method in the pancreatic pseudocyst even in case of severe abdominal adhesion.
Debridement ; Diet ; Drainage ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Chronic ; Recurrence ; Ultrasonography

Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD.
Constriction, Pathologic ; Drainage* ; Endoscopy ; Endosonography ; Humans ; Pancreatic Ducts* ; Pancreatitis, Chronic ; Patient Selection ; Stents ; Ultrasonography*

Since it was first described nearly three decades ago, endoscopic papillectomy (EP) has been utilized as a less invasive, alternative therapy for adenoma of the major duodenal papilla. In this article, we review the recent advances in EP, especially those pertaining to endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and pancreatic stent placement for the prevention of postpapillectomy pancreatitis. Because EUS and IDUS have similar diagnostic accuracies, either modality can be used for the preprocedural evaluation of ampullary tumors. Nevertheless, further technical refinements are required for a more precise evaluation. Given the paucity of data on the usefulness of EUS and/or IDUS during follow-up after EP, a well-designed study is warranted. Furthermore, pancreatic stent placement appears to have a protective effect against postpapillectomy pancreatitis; however, a prospective, randomized, controlled study with a larger number of patients is needed to assess this finding. Moreover, since pancreatic stent placement after EP is not always successful, various novel techniques have been developed to ensure reliable stent placement. Despite the recent advances in EP, further technical refinements and studies are needed to confirm their efficacy.
Adenoma ; Ampulla of Vater* ; Endosonography* ; Follow-Up Studies ; Humans ; Pancreatitis ; Stents* ; Ultrasonography*