Endoscopic drainage of pancreatic fluid collections and pancreatic necrosis

PFCs are heterogeneous, with different underlying pathology and pathophysiology. Each type of PFC is amenable to drainage, although not in every patient. Collections with only a fluid component that have either apposition to the gastric or duodenal wall demonstrated by CT or communication with the main pancreatic duct demonstrated by pancreatography can be drained endoscopically using transmural or transpapillary approaches, respectively. Collections containing significant amounts of solid debris that are treated endoscopically require placement of an irrigation system to evacuate solid debris. Endoscopists considering endoscopic therapy of a pancreatic collection must identify the type of collection being drained and exclude masqueraders of PFCs such as cystic neoplasms. EUS-guided drainage, if available, may decrease the complications of bleeding and perforation during transmural entry of PFCs. Refinement in endoscopic techniques to improve the safety and studies comparing the efficacy of endoscopic therapy with that of other drainage methods are needed.