| Theme |
Diagnostic and Interventional EUS -- Present Status and Future Perspectives |
| Title |
EUS-guided Drainage of Pancreatic Pseudocysts and Necrosectomy |
| Author |
Tomohisa Iwai |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Mitsuhiro Kida |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Hiroshi Yamauchi |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Kosuke Okuwaki |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Shiro Miyazawa |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Miyoko Takezawa |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Hidehiko Kikuchi |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Maya Watanabe |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Hiroshi Imaizumi |
Department of Gastroenterology, Kitasato University East Hospital |
| Author |
Wasaburo Koizumi |
Department of Gastroenterology, Kitasato University East Hospital |
| [ Summary ] |
Infected pancreatic pseudocysts and pancreatic necrosis are major risk factors for sepsis related multiple organ failure, which is the primary life-threatening complication associated with these conditions. The approach to treatment of these disorders has shifted from open surgery to endoscopic procedures. If the pseudocyst is not infected and is connected with the main pancreatic duct, transpapillary procedures should be carried out. In cases with infected pseudocysts or walled-off necrosis (WON), EUS guided cyst drainage (EUS-CD) should be performed. When removal of necrotic material is required, endoscopic necrosectomy (EN), an agrressive endoscopic technique, consisting of inserting an endoscope directly into the necrotic cavity and removing necrotic tissue, has become widespread. EUS-CD and EN can be effective for infected pseudocysts and WON. However, serious complications may arise, including death. Further research into safer techniques is required to reduce associated morbidity and mortality. Development of specialized devices is anticipated. |