A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy

Jintao Guo, Adrian Saftoiu, Peter Vilmann, Pietro Fusaroli, Marc Giovannini, Girish Mishra, Surinder S. Rana, Sammy Ho, Jan Werner Poley, Tiing Leong Ang, Evangelos Kalaitzakis, Ali A. Siddiqui, Jose G. De La Mora-Levy, Sundeep Lakhtakia, Manoop S. Bhutani, Malay Sharma, Shuntaro Mukai, Pramod Kumar Garg, Linda S. Lee, Juan J. Vila & 3 others Everson Artifon, Douglas G. Adler, Siyu Sun

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-offnecrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peripancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.

Original languageEnglish (US)
Pages (from-to)285-291
Number of pages7
JournalEndoscopic Ultrasound
Volume6
Issue number5
DOIs
StatePublished - Sep 1 2017

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Drainage
Stents
Metals
Therapeutic Irrigation
Standard of Care
Practice Guidelines
Hydrogen Peroxide
Surveys and Questionnaires

Keywords

  • Consensus
  • Endoscopic necrosectomy
  • Endoscopic ultrasound
  • Peri-pancreatic fluid collection

ASJC Scopus subject areas

  • Hepatology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. / Guo, Jintao; Saftoiu, Adrian; Vilmann, Peter; Fusaroli, Pietro; Giovannini, Marc; Mishra, Girish; Rana, Surinder S.; Ho, Sammy; Poley, Jan Werner; Ang, Tiing Leong; Kalaitzakis, Evangelos; Siddiqui, Ali A.; De La Mora-Levy, Jose G.; Lakhtakia, Sundeep; Bhutani, Manoop S.; Sharma, Malay; Mukai, Shuntaro; Garg, Pramod Kumar; Lee, Linda S.; Vila, Juan J.; Artifon, Everson; Adler, Douglas G.; Sun, Siyu.

In: Endoscopic Ultrasound, Vol. 6, No. 5, 01.09.2017, p. 285-291.

Research output: Contribution to journalArticle

Guo, J, Saftoiu, A, Vilmann, P, Fusaroli, P, Giovannini, M, Mishra, G, Rana, SS, Ho, S, Poley, JW, Ang, TL, Kalaitzakis, E, Siddiqui, AA, De La Mora-Levy, JG, Lakhtakia, S, Bhutani, MS, Sharma, M, Mukai, S, Garg, PK, Lee, LS, Vila, JJ, Artifon, E, Adler, DG & Sun, S 2017, 'A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy', Endoscopic Ultrasound, vol. 6, no. 5, pp. 285-291. https://doi.org/10.4103/eus.eus_85_17
Guo, Jintao ; Saftoiu, Adrian ; Vilmann, Peter ; Fusaroli, Pietro ; Giovannini, Marc ; Mishra, Girish ; Rana, Surinder S. ; Ho, Sammy ; Poley, Jan Werner ; Ang, Tiing Leong ; Kalaitzakis, Evangelos ; Siddiqui, Ali A. ; De La Mora-Levy, Jose G. ; Lakhtakia, Sundeep ; Bhutani, Manoop S. ; Sharma, Malay ; Mukai, Shuntaro ; Garg, Pramod Kumar ; Lee, Linda S. ; Vila, Juan J. ; Artifon, Everson ; Adler, Douglas G. ; Sun, Siyu. / A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. In: Endoscopic Ultrasound. 2017 ; Vol. 6, No. 5. pp. 285-291.
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