The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Endoscopic Management in Patients with Acute Pancreatitis

급성 췌장염에서의 내시경 역할

  • Kim, Tae Hyeon (Department of Internal Medicine, Wonkwang Univeristy School of Medicine)
  • 김태현 (원광대학교 의과대학 내과학교실)
  • Published : 2013.08.01
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Abstract

Inflammatory pancreatic fluid collection, such as pseudocysts, pancreatic abscesses and infected walled-off pancreatic necrosis, arise as a complication of acute pancreatitis. Recently endoscopic ultrasound (EUS)-guided drainage has emerged as the leading treatment modality for symptomatic pancreatic fluid collection. EUS-guided endoscopic drainage is less invasive than surgery and avoids local complications related to percutaneous drainage. In addition, this endoscopic treatment can drain non-bulging fluid collection and may reduce the risk of procedure related bleeding and perforation. Excellent treatment success rates exceeding 90% have been reported for pancreatic pseudocysts and abscesses. Intervention such as endoscopic drainage with necrosectomy may be indicated for infected pancreatic necrosis, and ideally be delayed as long as possible, 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Multimodal treatments by specialists with specific expertise in management of peripancreatic fluid collection is essential to achieve the best outcomes. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected.

Keywords

References

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