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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2018; 6(10): 308-321
Published online Sep 26, 2018. doi: 10.12998/wjcc.v6.i10.308
Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections
Tian-An Jiang, Li-Ting Xie
Tian-An Jiang, Li-Ting Xie, Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tian-An Jiang, MD, PhD, Professor, Surgeon, Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road, No. 79, Hangzhou 310003, Zhejiang Province, China. tiananjiang@zju.edu.cn
Received: May 17, 2018
Peer-review started: May 21, 2018
First decision: June 20, 2018
Revised: July 5, 2018
Accepted: July 15, 2018
Article in press: July 16, 2018
Published online: September 26, 2018
Processing time: 132 Days and 16.1 Hours
Abstract

Pancreatic fluid collections (PFCs), common sequelae of acute or chronic pancreatitis, are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification. Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC. EUS-guided drainage is effective and successful; it has a technical success rate of 90%-100% and a clinical success rate of 85%-98%. Recent studies have shown a 5%-30% adverse events (AEs) rate for the procedure. The most common AEs include infection, hemorrhage, perforation and stent migration. Hemorrhage, a severe and sometimes deadly outcome, requires a well-organized and appropriate treatment strategy. However, few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC. Establishing a practical therapeutic strategy is an essential and significant step in standardized management. The aim of this review is to describe the current situation of EUS-guided drainage of PFCs, including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives. We propose a novel and meaningful algorithm for systematically managing hemorrhage events. To our limited knowledge, a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.

Keywords: Pancreatic fluid collections; Hemorrhage; Endoscopic ultrasound-guided; Treatment algorithm; Adverse events

Core tip: Currently, endoscopic ultrasound (EUS)-guided drainage has been viewed as the optimal therapy for symptomatic pancreatic fluid collections (PFCs). Bleeding is one of the most dangerous adverse events. However, few studies have addressed the treatment of hemorrhage in the EUS-guided drainage of PFCs. The aim of this review is to describe the etiology, therapy, and prevention of EUS-guided drainage procedure-related bleeding and to present current problems and future perspectives. Moreover, we propose a meaningful and multidisciplinary algorithm for the clinical management of hemorrhagic events in EUS-guided drainage for PFCs.