Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2021; 13(7): 633-644
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.633
Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis
Nian-Jun Xiao, Ting-Ting Cui, Fang Liu, Wen Li
Nian-Jun Xiao, Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
Nian-Jun Xiao, Ting-Ting Cui, Fang Liu, Department of Gastroenterology and Hepatology, Medical School of Chinese People's Liberation Army, Beijing 100853, China
Ting-Ting Cui, Fang Liu, Wen Li, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Author contributions: Xiao NJ and Li W contributed to the review design; Xiao NJ wrote the manuscript; Xiao NJ and Cui TT edited the manuscript; Cui TT contributed to the audio core tip; Liu F and Li W contributed to the manuscript revising.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other co-authors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Wen Li, MD, PhD, Chief Doctor, Executive Vice President, Professor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: May 4, 2021
Revised: May 16, 2021
Accepted: June 15, 2021
Article in press: June 15, 2021
Published online: July 27, 2021

Pancreatic and peripancreatic collections are the main local complications of acute pancreatitis with a high incidence. In the early phase, most acute pancreatic and peripancreatic collections can resolve spontaneously with supportive treatment. However, in some cases, they will develop into pancreatic pseudocyst (PPC) or walled-off necrosis (WON). When causing symptoms or coinfection, both PPC and WON may require invasive intervention. Compared to PPC, which can be effectively treated by endoscopic ultrasound-guided transmural drainage with plastic stents, the treatment of WON is more complicated and challenging, particularly in the presence of infected necrosis. In the past few decades, with the development of minimally invasive interventional technology especially the progression of endoscopic techniques, the standard treatments of those severe complications have undergone tremendous changes. Currently, based on the robust evidence from randomized controlled trials, the step-up minimally invasive approaches have become the standard treatments for WON. However, the pancreatic fistulae during the surgical step-up treatment and the stent-related complications during the endoscopic step-up treatment should not be neglected. In this review article, we will mainly discuss the indications of PPC and WON, the timing for intervention, and minimally invasive treatment, especially endoscopic treatment. We also introduced our preliminary experience in endoscopic gastric fenestration, which may be a promising innovative method for the treatment of WON.

Keywords: Pancreatic pseudocyst, Walled-off necrosis, percutaneous drainage, Minimally invasive surgery, Endoscopic necrosectomy, Endoscopic gastric fenestration

Core Tip: Conservative treatment is suitable for most pancreatic pseudocysts. The endoscopic ultrasound-guided transmural drainage with plastic stents may be the preferred therapy for pancreatic pseudocysts if they are symptomatic. Combined transpapillary drainage is not routinely suggested. Walled-off necrosis requires invasive intervention except for sterile asymptomatic walled-off necrosis. The timing of intervention is debatable in the era of minimal invasion. The endoscopic step-up approach is the preferred treatment for walled-off necrosis, whereas percutaneous drainage followed by minimally invasive surgery is an important alternative therapy. The innovative approach of endoscopic gastric fenestration without any stent may be a promising procedure in selected patients.