Endoscopic management of pancreatic fluid collections-revisited

Figure 1 Technique of endoscopic ultrasonography guided drainage of pancreatic fluid collection. A: EUS evaluation of pancreatic fluid collection; B: Puncture of pancreatic fluid collections (PFC) wall with 21 G fine needle aspiration needle; C: Coiling of guidewire inside PFC cavity; D: Enlarging the cysto-gastric tract with balloon; E: Placement of stent under EUS-guidance; F: Final position of stent after placement.

Figure 2 Differentiation of pancreatic fluid collections on endoscopic ultrasonography after 4 wk. A: Pseudocyst - note the clear contents of a pseudocyst (without solid debris); B: Walled off necrosis- note the presence of debris inside the cyst cavity.

Figure 3 Specially designed bi-flanged metal stent (Nagi stent, Taewoong Medical Co, Ilsan, South Korea) for drainage of pancreatic fluid collection.

Figure 4 Direct endoscopic necrosectomy. A: Removal of necrotic debris with a snare; B: After completion of endoscopic necrosectomy.

Figure 5 Algorithmic approach to the management of pancreatic fluid collections. EUS: Endoscopic ultrasound; MRI: Magnetic resonance imaging; PD: Pancreatic duct; ERCP: Endoscopic retrograde cholangiopancreatography.