Endoscopic approach to pancreatic pseudocyst abscess and necrosis.pdf

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2017-04-09 发布于江苏
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Endoscopic approach to pancreatic pseudocyst abscess and necrosis.pdf

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Endoscopic approach to pancreatic pseudocyst abscess and necrosis

REVIEWden_1298 299..308 Endoscopic approach to pancreatic pseudocyst, abscess and necrosis: Review on recent progress Jie Chen,1 Norio Fukami2 and Zhaoshen Li1 1Department of Gastroenterology, Changhai Hospital, Shanghai, China, and 2Division of Gastroenterology and Hepatology, University of Colorado Hospital, Denver, USA Aim: The aim of this study is to introduce recent progress in the treatment of pancreatic pseudocyst, abscess and necrosis using the endoscopic approach. Methods: Studies on PubMed and MEDLINE from the last 30 years on progress in the management of the complications from severe pancreatitis were researched and reviewed. Herein, the indication for intervention, definition of fluid collection associated with acute pancreatitis and treatment modalities of these complications are summarized. Results: Three types of management are employed for complications of severe pancreatitis: the endoscopic, surgical and percutaneous approaches. Conclusions: Over the years, as technical expertise has increased and instruments for endoscopy have improved, patients who had endoscopic surgery to address the complications of severe pancreatitis have had higher survival rates, lower mortality rates and lower complication rates than those having open debridement. However, traditional open abdominal surgery should be advocated when minimally invasive management fails or necrosis is extensive and extends diffusely to areas such as the paracolic gutter and the groin (i.e. locations not accessible by endoscopy). Key words: abscess, endoscopy, necrosis, pancreatic pseudocyst. INTRODUCTION Severe acute pancreatitis is a serious medical problem with significant morbidity and mortality.1 The mortality rate range is 10–25%.2,3 Patients who deteriorate clinically often have complications involving pancreatic or peripancreatic tissue necrosis and may have a secondary infection, which could lead to sepsis, multiple organ failure and death.2 Intervention to remove the infected necros