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Year : 2017  |  Volume : 6  |  Issue : 5  |  Page : 285-291

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

1 Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
2 Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
3 Endoscopy Department, GastroUnit, Copenhagen University Hospital, Copenhagen, Denmark
4 Gastroenterology Unit, University of Bologna, Bologna, Italy
5 Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
6 Wake Forest Baptist Health, Winston-Salem, NC, USA
7 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
8 Montefiore Medical Center, New York, USA
9 Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
10 Gastroenterology Department, Changi General Hospital, Singapore
11 Endoscopy Unit, Digestive Disease Center, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
12 Division of Digestive and Liver Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, USA
13 Gastroenterology Division, National Cancer Institute, City, Mexico
14 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, USA
15 MD Anderson Cancer Center, University of Texas, Houston, TX, USA
16 Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, USA
17 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
18 Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
19 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
20 Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
21 Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
22 Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA

Correspondence Address:
Douglas G Adler
Department of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT 84132
Siyu Sun
Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_85_17

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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-off necrosis (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 peri-pancreatic 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.

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