What is the role of image guided PCD in the treatment of infected ANC and WON? The role of PCD in the management of infected ANC and WON is controversial. Open surgical necrosectomy is still considered the gold standard treatment in infected pancreatic necrosis, because it involves nonliquefactive tissue that is difficult to remove with …
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What are the similarities and differences between an ANC and WON? Both collections can be intrapancreatic or extrapancreatic, associated with necrotizing pancreatitis, and contain variable amounts of fluid and solid necrotic tissue. An ANC occurs within the first 4 weeks and does not have a definable wall encapsulating the collection. WON occurs 4 weeks or …
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When is drainage indicated for treatment of pancreatic pseudocysts? Pancreatic pseudocysts usually occur 4 weeks after the onset of interstitial edematous pancreatitis, have a well-defined wall, and no nonliquid component. Drainage is indicated when pseudocysts are infected, rapidly enlarging, painful, obstructing, or large (≥ 5 cm). Drainage can be achieved via percutaneous image guidance, endoscopic …
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Do APFCs require percutaneous image guided treatment? APFCs are adjacent to the pancreas and extrapancreatic only. They occur during the first 4 weeks, have no discernible wall, and do not contain debris or necrosis. Most usually resolve spontaneously without intervention and do not become infected. Percutaneous image-guided drainage is only indicated if infected. The presence …
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What procedures are used for pancreatic and peripancreatic collections? Various acute and chronic pancreatic and peripancreatic collections can be percutaneously aspirated and drained using image guidance if clinically indicated. According to the revised Atlanta classification system for acute pancreatitis, collections should be defined as acute peripancreatic fluid collection (APFC), pancreatic pseudocyst, acute necrotic collection (ANC), …
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Can FNA be performed for solid pancreatic masses completely surrounded by the bowel? If a skinny needle (< 20 gauge) is used and the lesion is solid, any organ, including the stomach, small bowel, and colon, can be traversed. Antibiotic coverage is recommended for procedures through the bowel. Major blood vessels should be avoided. The …
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What procedures are appropriate for solid pancreatic masses? Solid masses, usually suspected tumors, can be aspirated percutaneously. Only FNAs should be performed; core biopsies should be avoided, because the use of cutting needles can result in severe pancreatitis. As noted previously, percutaneous biopsy of suspected cystadenomas or cystadenocarcinomas should be avoided.