Clinical Pancreatology for Practising Gastroenterologists and Surgeons. Группа авторов
it occurs, resuscitation and the urgent assistance of an interventional radiologist or experienced surgeon is required. Late bleeding appears more common with LAMS [12]. LAMS can induce both neovascularization and overgrowth of adjacent retroperitoneal tissues leading to bleeding at the time of removal, hence the need for earlier retrieval than plastic stents. Additionally, collapse of the cyst cavity can bring vessels into contact with the metal flange leading to abrasion and late bleeding.
Perforation due to stent misplacement is uncommon with EUS guidance in expert hands. However, rapid decompression of a large collection (particularly if the wall is not fully mature and adherent) may lead to dehiscence of the cyst wall from the stomach or duodenum and a clinically significant leak. This is less likely when a LAMS is used. ERCP and transpapillary drainage is associated with the additional risk of pancreatitis.
Conclusion
Endoscopy is well established as an important tool in the armamentarium of the multidisciplinary team managing pancreatic fluid collections. Despite improvements in technique and devices reflecting the complexity of the disease process, endoscopic drainage remains associated with significant morbidity and potential for mortality and careful patient selection and assesment is mandatory.
References
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