Endoscopic management of pancreatic fluid collections: New technology and techniques

Endoscopic ultrasound-guided drainage of pancreatic fluid collections has become a frontier for minimally invasive endoscopic interventions, which should be compared with the gold-standard drainage procedure, and its clinical resolution should be compared with that of invasive surgery and interventional radiological techniques. The major limitations of endoscopic ultrasound-guided interventions have been difficult multistep access procedures, incomplete drainage requiring rescue surgical drainage, and infrequent, but significant, complications. This review will address recent advances including forward-viewing echoendoscope technology, custom-designed access tools, improved drainage techniques, and modified fully covered self-expandable stents, which when integrated into these complex interventions can achieve excellent immediate technical success and high complete clinical resolution of a spectrum of pancreatic fluid collections including walled-off pancreatic necrosis and abscesses. (C) 2012 Elsevier Inc. All rights reserved.