TY - JOUR
T1 - 壊死性膵炎に対する様々な介入の最適時期は?
AU - WONDERFUL Study Group in Japan
AU - Nakai, Yousuke
AU - Hamada, Tsuyoshi
AU - Saito, Tomotaka
AU - Shiomi, Hideyuki
AU - Maruta, Akinori
AU - Iwashita, Takuji
AU - Iwata, Keisuke
AU - Takenaka, Mamoru
AU - Masuda, Atsuhiro
AU - Matsubara, Saburo
AU - Sato, Tatsuya
AU - Mukai, Tsuyoshi
AU - Yasuda, Ichiro
AU - Isayama, Hiroyuki
N1 - Publisher Copyright:
© 2024 Japan Gastroenterological Endoscopy Society. All rights reserved.
PY - 2024/9
Y1 - 2024/9
N2 - Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound-guided transluminal drainage combined with ondemand endoscopic necrosectomy (i.e. the step-up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.
AB - Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound-guided transluminal drainage combined with ondemand endoscopic necrosectomy (i.e. the step-up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.
KW - acute necrotizing pancreatitis
KW - drainage
KW - endoscopic ultrasound
KW - necrosectomy
KW - pancreatic fluid collection
UR - http://www.scopus.com/inward/record.url?scp=85204356922&partnerID=8YFLogxK
U2 - 10.11280/gee.66.1726
DO - 10.11280/gee.66.1726
M3 - 学術論文
AN - SCOPUS:85204356922
SN - 0387-1207
VL - 66
SP - 1726
EP - 1737
JO - Gastroenterological Endoscopy
JF - Gastroenterological Endoscopy
IS - 9
ER -