医学
经皮
心理干预
内镜超声检查
重症监护医学
急性胰腺炎
普通外科
胰管
不利影响
胰腺炎
放射科
外科
内窥镜检查
内科学
精神科
作者
Yousuke Nakai,Tomotaka Saito,Tsuyoshi Hamada,Tatsuya Sato,Ryunosuke Hakuta,Naminatsu Takahara,Hiroyuki Isayama,Ichiro Yasuda,Mitsuhiro Fujishiro
摘要
Walled‐off necrosis (WON) develops as local complications after acute necrotizing pancreatitis. Although less invasive interventions such as endoscopic ultrasonography (EUS)‐guided drainage and endoscopic necrosectomy are selected over surgical interventions, delayed and step‐up interventions are still preferred to avoid procedure‐related adverse events. However, there is a controversy about the appropriate timing of drainage and subsequent necrosectomy. The advent of large‐caliber lumen‐apposing metal stents has also brought about potential advantages of proactive interventions, which still needs investigation in future trials. When step‐up interventions of necrosectomy and additional drainage are necessary, a structured or protocoled approach for WON has been reported to improve safety and effectiveness of endoscopic and/or percutaneous treatment, but has not been standardized yet. Finally, long‐term outcomes such as recurrence of WON, pancreatic endocrine, and exocrine function are increasingly investigated in association with disconnected pancreatic duct syndrome. In this review we discuss current evidence and controversy on EUS‐guided management of WON.
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