Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 189

Endoscopic transmural drainage of PP was first described in 1985 and has subsequently evolved [11]. Endoscopic drainage has become the preferred standard of care for symptomatic PP. In a single‐center, randomized prospective trial of 40 patients with PP by Varadarajulu et al. [12], endoscopic cystgastrostomy (n = 20) was equally technically effective as surgical cystgastrostomy (n = 20); endoscopic drainage was associated with the significant benefits of shortened length of hospital stay and lower associated hospital costs, with a greater than 50% reduction in both parameters in the endoscopic group. It is of critical importance to accurately differentiate between PP and WON as the subsequent management strategies are markedly different. At times, computed tomography (CT) may miss components of solid debris inside the collection, which may be seen on magnetic resonance imaging (MRI) or endoscopic ultrasound (EUS). Additionally, EUS not only allows real‐time assessment of a collection’s characteristics but also has the ability to provide intervention if indicated. PPs should be distinguished from potential cystic neoplasms. Attention to a careful history regarding pancreatitis is helpful as a preceding history of pancreatitis increases the likelihood of the lesion being a PP whereas no history of pancreatitis favors the possibility of a cystic neoplasm. The approach to drainage of PPs will be dictated based on their size, location, anatomy, and any component of pancreatic ductal disruption that may be present. In the case of ductal disruptions, endoscopic retrograde cholangiopancreatography (ERCP) may be undertaken to enable transpapillary drainage to correct the underlying etiology in addition to other therapeutic modalities for PP drainage. The vast majority of these PPs are now drained transmurally, primarily under EUS guidance. This drainage can be done using plastic double‐pigtail stents or lumen apposing metal stents (LAMS).