Percutaneous drainage of pancreatic fluid collections

Percutaneous drainage has a major role in the treatment of patients who develop pancreatic fluid collections complicating pancreatitis. The participation of the interventionalist in the management of patients with pancreatic fluid collections involves imaging assessment, appropriate indication for drainage, percutaneous drainage performance, and follow-up of th catheter and the patient. Thorough knowledge of the disease, technical skills, and clinical involvement for each individual case are essential for successful therapy. Inflammatory disease of the pancreas remains a controversial topic. Advances in the understanding of the pathophysiology of the disease and major imaging improvements have not been able to resolve the debate on how to define and correlate clinical with imaging findings. World experts, including surgeons, gastroenterologists, and radiologists have gathered in Marseille (1963 and 1984),(1,2) Cambridge (1983),(3) and Atlanta (1992)(4) to discuss the definition and clinical significance of different acute pancreatitis lesions. In spite of their efforts, confusion with the terminology persists among investigators, making it difficult to compare patients and treatment results from published series. Treatment of pancreatitis has swung from extreme treatments such as ''emergency'' pancreatectomy(5) or papillotomy for acute pancreatitis(6) to the more conservative approach of vigorous medical support and observation. This article presents a review of general concepts of inflammatory disease of the pancreas, its current imaging, and treatment. We will focus on percutaneous drainage, its indications, technique, and results.