LAUSR

The 2012 revised Atlanta classification defines pancreatic fluid collections (PFCs) as acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, or walled-off necroses (WONs). Pseudocysts and WONs have an organized wall around the collection, which usually develops at least 4 weeks after the onset of acute pancreatitis. Pancreatic pseudocysts and WONs can also occur in patients with chronic pancreatitis by an acute exacerbation of pancreatitis or by progressive ductal obstruction. Drainage of pancreatic pseudocysts or WONs is necessary in patients who are symptomatic or have biliary or intestinal obstruction or if the size of the collection increases rapidly. Endoscopic drainage is an accepted alternative to surgical or radiology-guided percutaneous drainage when intervention is indicated. One recent single-center randomized trial showed that endoscopic drainage for infected necrotizing pancreatitis significantly reduces major complications, lowers costs, and increases quality of life compared with minimally invasive surgery. Endoscopic transmural drainage can be performed by conventional endoscopy or endoscopic ultrasound (EUS). EUS-guided drainage of PFCs is now the standard of care because it enables identification of intervening vasculature, assessment of the distance between the lumen and PFC, and makes the procedure possible when definitive luminal compression is not endoscopically visible. In this issue of Clinical Endoscopy, Shin et al. present a retrospective study comparing the clinical outcome of EUS-guided drainage of PFCs between using a plastic stent (PS) and lumen-apposing metal stent (LAMS). The technical success rate was similar in both groups (94.1% vs. 100%, p=1.0), but the procedure time was significantly shorter in the LAMS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Clinical success was achieved in all patients with technical success, but recurrence of PFCs after stent removal occurred in 41.7% and 40.0% (p=1.0) in the PS and LAMS groups, respectively. One should be cautious while interpreting the results from this study because it was retrospective in design, involved a relatively small number of patients, and was conducted over a 7-year period (from January 2011 to December 2017). EUS-guided transmural drainage of PFCs with PSs was performed in the initial period of procedure development (17 patients between January 2011 and October 2016), whereas the 10 LAMS procedures (SPAXUS; Taewoong Medical, Seoul, Korea) were performed between October 2016 to December 2017. This also highlights the difference in workload; the 17 PS procedures were completed over a 6-year period (3 patients per year), whereas the 10 LAMS procedures were all done in 1 year. The reported recurrence rate of PFCs after successful drainage by EUS-guided transmural drainage varies in the Received: July 8, 2019 Accepted: July 10, 2019 Correspondence: Robert H. Hawes Center for Interventional Endoscopy, AdventHealth Orlando, 601 E Rollins St, Orlando, FL 32803, USA Tel: +1-407-609-3355, Fax: +1-407-303-0795, E-mail: [email protected] ORCID: https://orcid.org/0000-0003-2709-8530