Management of complications of acute pancreatitis

Acute pancreatitis can result in a number of localized complications such as pancreatic pseudocysts, walled-off pancreatic necrosis (WON), and disconnected pancreatic duct syndrome (DPDS). The management of these conditions has evolved over the past three decades such that minimally invasive endoscopic drainage and debridement methods are now the favored, first-line approach. This article will review the latest developments and controversies regarding the endoscopic management of these conditions.

For patients with pancreatic pseudocysts, it remains to be clear what the role of routine ERCP is in this population. For WON, it is clear that when expertise is available, a minimally invasive approach may be the most suitable option. There is a growing literature raising concern about LAMS-associated bleeding in this group, however. Alterations in LAMS placement and stent dwell time may reduce this risk. Lastly, recognition of the DPDS is an important factor that needs to be recognized whenever present, as these patients will require a long-term management strategy and may require multimodality intervention.

Despite the development of new endoscopic techniques and dedicated devices for managing pancreatic fluid collections and disconnected pancreatic duct syndrome, a number of issues remain unresolved in terms of best practice methods.