Resumo

CASASOLA-SANCHEZ, Luis Eduardo; RODRIGUEZ-SANCHEZ, José Froylán; SAUL, Ángela  e  TELLEZ-AVILA, Félix Ignacio. Infected pancreatic necrosis: more frequent doubts. Endoscopia [online]. 2019, vol.31, n.1, pp.40-46.  Epub 25-Out-2021. ISSN 2444-6483.  https://doi.org/10.24875/end.m19000004.

The drainage of pancreatic collections has evolved over the years as new techniques are developed, being the endoscopic ultrasound (EUS) the first line treatment. To improve the effectiveness of endoscopic drainage of encapsulated pancreatic necrosis, strategies have been used, such as the placement of multiple stents, larger caliber stents, direct endoscopic necrosectomy and the placement of a naso-colection probe for irrigation, increasing drainage success by up to 70-90%. Even with these results there are different points of debate in the drainage of the collections: a) the ideal moment for the evaluation of the pancreatic duct, which can be disconnected up to 50% of the cases, as well as the benefit of placement a pancreatic transpapillary stent, which until now has not shown a greater benefit to transmural drainage; b) despite the theoretical advantages of metal stents over plastic in the short time of procedure, less permanence and overall cost, recent studies have not shown difference in success when they have been compared, and c) although it has been little studied, retrospective studies have shown an improvement in the clinical success of the drainage of collections containing detritus up to 3 times when leaving a nasocystic drainage for 2 weeks or until improving signs of sepsis. Due to the above, EUS continues to present advantages that make it the treatment of choice, allowing a greater number of collections to be susceptible to drainage with less risk of complications.

Palavras-chave : México; Endoscopic ultrasound; Pancreatic necrosis; Transmural drainage; Transpapillary drainage; Endoscopic necrosectomy.

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