scholarly journals Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines

Endoscopy ◽  
2018 ◽  
Vol 50 (05) ◽  
pp. 524-546 ◽  
Author(s):  
Marianna Arvanitakis ◽  
Jean-Marc Dumonceau ◽  
Jörg Albert ◽  
Abdenor Badaoui ◽  
Maria Bali ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Infected Necrosis ◽  
Strong Recommendation ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
Contrast Enhanced ◽  
Acute Necrotizing ◽  
Walled Off Necrosis ◽  
Quality Evidence

MAIN RECOMMENDATION 1 ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2 ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3 ESGE recommends initial goal-directed intravenous fluid therapy with Ringer’s lactate (e. g. 5 – 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4 ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5 ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6 ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7 ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8 ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence.

scholarly journals Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. 989-1006 ◽  
Author(s):  
Marcin Polkowski ◽  
Christian Jenssen ◽  
Philip Kaye ◽  
Silvia Carrara ◽  
Pierre Deprez ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Solid Component ◽  
Cystic Lesions ◽  
High Quality ◽  
Strong Recommendation ◽  
Fine Needle ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Quality Evidence

RECOMMENDATIONSFor routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

scholarly journals Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Endoscopy ◽  
2019 ◽  
Vol 51 (12) ◽  
pp. 1155-1179 ◽  
Author(s):  
Raf Bisschops ◽  
James E. East ◽  
Cesare Hassan ◽  
Yark Hazewinkel ◽  
Michał F. Kamiński ◽  
...  
Keyword(s):  
Colorectal Neoplasia ◽  
Colorectal Polyps ◽  
High Definition ◽  
High Quality ◽  
Strong Recommendation ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Virtual Chromoendoscopy ◽  
Quality Evidence

Main Recommendations 1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

scholarly journals Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

Endoscopy ◽  
2017 ◽  
Vol 49 (07) ◽  
pp. 695-714 ◽  
Author(s):  
Jean-Marc Dumonceau ◽  
Pierre Deprez ◽  
Christian Jenssen ◽  
Julio Iglesias-Garcia ◽  
Alberto Larghi ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Patient Management ◽  
Local Treatment ◽  
Endobronchial Ultrasound ◽  
Left Liver Lobe ◽  
Strong Recommendation ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
Pathological Result ◽  
Quality Evidence

MAIN RECOMMENDATIONSFor pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.Strong recommendation, low quality evidence.For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.Weak recommendation, low quality evidence.For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.Strong recommendation, moderate quality evidence.In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.Weak recommendation, low quality evidence.

scholarly journals Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopy ◽  
2021 ◽  
Author(s):  
Schalk W. van der Merwe ◽  
Roy L. J. van Wanrooij ◽  
Michiel Bronswijk ◽  
Simon Everett ◽  
Sundeep Lakhtakia ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Outlet Obstruction ◽  
Strong Recommendation ◽  
Gallbladder Drainage ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
Quality Evidence

Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.

Mo1426 Prediction of Progression to Walled-Off Necrosis in Acute Necrotizing Pancreatitis With Pancreatic Perfusion CT

2016 ◽  
Vol 150 (4) ◽  
pp. S709
Author(s):  
Akira Yamamiya ◽  
Katsuya Kitamura ◽  
Yu Ishii ◽  
Tomohiro Nomoto ◽  
Tadashi Honma ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Perfusion Ct ◽  
Acute Necrotizing Pancreatitis ◽  
Acute Necrotizing ◽  
Walled Off Necrosis ◽  
Pancreatic Perfusion

scholarly journals Surgery Management of Pancreatitis with Complication: A Review Article

2022 ◽  
Vol 6 (1) ◽  
pp. 01-03
Author(s):  
Nanda Rachmad Putra Gofur ◽  
Aisyah Rachmadani Putri Gofur ◽  
Soesilaningtyas Soesilaningtyas ◽  
Rizki Nur Rachman Putra Gofur ◽  
Mega Kahdina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Necrotizing Pancreatitis ◽  
Clinical Manifestations ◽  
Healing Time ◽  
Acute Necrotizing Pancreatitis ◽  
Close Monitoring ◽  
Necrotic Tissue ◽  
Acute Necrotizing ◽  
Walled Off Necrosis

Introduction: Acute pancreatitis is an inflammatory disease of the pancreas with clinical manifestations that vary from mild to severe manifestations to death. The incidence of pancreatitis varies in various countries in the world and depends on the cause such as alcohol, gallstones, and metabolic factors. The clinical picture and the main symptom in patients with acute pancreatitis is abdominal pain. Abdominal pain varies from mild to severe and excruciating. Abdominal pain that is felt is constant and dull, and is usually felt in the epigastrium and periumbilicus and often spreads to the back, chest, waist, and lower abdomen. Discussion: The onset of acute pancreatitis, the patient should be evaluated for hemodynamic status immediately and receive the necessary resuscitation measures. Patients with acute pancreatitis should receive aggressive intravenous rehydration (250 - 500 ml/hour with isotonic crystalloid fluid) as early as possible with close monitoring, unless contraindicated with cardiovascular and/or renal comorbidities. It is most effective within the first 12-24 hours, but after that the benefits may diminish. Debridement (necrosectomy) is the gold standard in infected acute necrotizing pancreatitis and peripancreatic necrosis. Indications for intervention either through radiological, endoscopic or surgical procedures in necrotizing pancreatitis are suspected or proven infected necrotizing pancreatitis with clinical deterioration, especially after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Sterile necrotizing pancreatitis with persistent organ failure several weeks after the onset of acute pancreatitis, particularly after the necrotic tissue has been encapsulated with thick walls (walled-off necrosis). Conclusion: Surgical management is often used in pancreatitis associated with gallstones. Cholecystectomy within 48 hours of the complaint can increase healing time. In addition, cholecystectomy performed early may not increase the risk of complications secondary to surgery. Surgery is not performed in acute necrotizing pancreatitis until the inflammation is reduced and the fluid accumulation no longer increases in size.

scholarly journals Spontaneous Rupture of Infected Walled-Off Necrosis in the Transverse Colon with a Nonoperative Favorable Outcome: A Rare Event

2019 ◽  
Vol 10 (04) ◽  
pp. 237-239
Author(s):  
Virender Chauhan ◽  
Gaurav Kumar Gupta ◽  
Vasudha Goel ◽  
Dilip Singh Mudgal ◽  
Mukesh Jain ◽  
...  
Keyword(s):  
Transverse Colon ◽  
Spontaneous Rupture ◽  
Necrotizing Pancreatitis ◽  
Rare Event ◽  
Spontaneous Resolution ◽  
Acute Necrotizing Pancreatitis ◽  
Favorable Outcome ◽  
Mortality And Morbidity ◽  
Acute Necrotizing ◽  
Walled Off Necrosis

AbstractInfected walled-off necrosis (WON) is a well-known complication of acute necrotizing pancreatitis, with higher mortality and morbidity. An infected or symptomatic WON requires drainage. Occasionally, WON may spontaneously fistulize into the gastrointestinal lumen or may rupture into the peritoneum. We describe a case of spontaneous rupture of WON in the transverse colon with uncomplicated spontaneous resolution, which is an extremely rare event.

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