The Role of Imaging-Guided Percutaneous Procedures in the Multidisciplinary Approach to Treatment of Pancreatic Fluid Collections

Abstract

Pancreatic fluid collections include a wide range of entities such as cystic neoplasms, both benign and malignant; vascular pathology such as pseudoaneurysms and hematomas; and a host of other entities such as pseudocysts, seromas, abscesses, and bilomas. The distinction between these entities requires correlating an often complex and overlapping clinical presentation with findings on imaging studies, typically computed tomography, magnetic resonance imaging, and ultrasound. As complex as the diagnostic work-up may be, the treatment of pancreatic collections poses its own set of challenges and often requires a multidisciplinary collaboration among interventional radiologists, surgeons, and gastroenterologists. The best treatment algorithm is determined by careful review of radiologic imaging studies combined with endoscopic retrograde cholangiopancreatography to apply therapies such as surgical resection; drainage or debridement; endoscopic ultrasound-guided drainage; aspiration or biopsy; and imaging-guided percutaneous drainage, aspiration, or biopsy. This article focuses on the diagnosis and multidisciplinary management of pancreatic fluid collections such as abscesses, pseudocysts, and necrosis.

Keywords

interventional radiology - pancreas - percutaneous drainage - abscess - pancreatitis

• References

• 1 Memi A, Parildar M. Intervent radiological treatment in complications of pancreatitis. Eur J Radiol 2002; 43 (3) 577-582
• 2 Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 2012; 262 (3) 751-764
• 3 Lorenz JM, Funaki BS, Ray Jr CE , et al. ACR Appropriateness Criteria on percutaneous catheter drainage of infected fluid collections. J Am Coll Radiol 2009; 6 (12) 837-843
• 4 D'Egidio A, Schein M. Pancreatic pseudocysts: a proposed classification and its management implications. Br J Surg 1991; 78 (8) 981-984
• 5 Vila JJ, Carral D, Fernández-Urien I. Pancreatic pseudocyst drainage guided by endoscopic ultrasound. World J Gastrointest Endosc 2010; 2 (6) 193-197
• 6 Cahen D, Rauws E, Fockens P, Weverling G, Huibregtse K, Bruno M. Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment. Endoscopy 2005; 37 (10) 977-983
• 7 Nealon WH, Walser E. Main pancreatic ductal anatomy can direct choice of modality for treating pancreatic pseudocysts (surgery versus percutaneous drainage). Ann Surg 2002; 235 (6) 751-758
• 8 Cantasdemir M, Kara B, Kantarci F, Mihmanli I, Numan F, Erguney S. Percutaneous drainage for treatment of infected pancreatic pseudocysts. South Med J 2003; 96 (2) 136-140
• 9 Fernández-Cruz L, Sáenz A, Astudillo E, Pantoja JP, Uzcátegui E, Navarro S. Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc 2002; 16 (6) 996-1003
• 10 Tang LJ, Wang T, Cui JF , et al. Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection. World J Gastroenterol 2010; 16 (4) 513-517
• 11 vanSonnenberg E, Wittich GR, Chon KS , et al. Percutaneous radiologic drainage of pancreatic abscesses. AJR Am J Roentgenol 1997; 168 (4) 979-984
• 12 Mithöfer K, Mueller PR, Warshaw AL. Interventional and surgical treatment of pancreatic abscess. World J Surg 1997; 21 (2) 162-168
• 13 Lee MJ, Rattner DW, Legemate DA , et al. Acute complicated pancreatitis: redefining the role of interventional radiology. Radiology 1992; 183 (1) 171-174
• 14 Seewald S, Ang TL, Teng KC, Soehendra N. EUS-guided drainage of pancreatic pseudocysts, abscesses and infected necrosis. Dig Endosc 2009; 21 (Suppl. 01) S61-S65