Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections

摘要

Pancreatic fluid collections(PFCs),common sequelae of acute or chronic pancreatitis,are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification.Endoscopic ultrasound(EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC.EUS-guided drainage is effective and successful;it has a technical success rate of 90%-100%and a clinical success rate of 85%-98%.Recent studies have shown a 5%-30%adverse events(AEs)rate for the procedure.The most common AEs include infection,hemorrhage,perforation and stent migration.Hemorrhage,a severe and sometimes deadly outcome,requires a well-organized and appropriate treatment strategy.However,few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC.Establishing a practical therapeutic strategy is an essential and significant step in standardized management.The aim of this review is to describe the current situation of EUS-guided drainage of PFCs,including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives.We propose a novel and meaningful algorithm for systematically managing hemorrhage events.To our limited knowledge,a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.