Table 2 Endoscopic treatment options for the management of pancreatic fluid collections

Transmural endoscopic drainage with plastic stents

• Cystogastrostomy

• Cystoduodenostomy

Double-pigtail

7-10 Fr

• Low cost

• Easy placement and removal

• Active or passive drainage (with or without nasocystic drain)

• Small caliber (increased risk of occlusion and secondary infection)

• Often need for multiple stents

• Possibility of fluid leak and migration

• Poor visibility under fluoroscopy during the procedure

Transmural endoscopic drainage with FCSEMSs

• Cystogastrostomy

• Cystoduodenostomy

Tubular biliary stents

6-10 mm

• Large caliber

• Possibility to perform DEN through stent

• Prevent fluid leak

• Good visibility under fluoroscopy

• Haemostatic effect at puncture site

• Cost

• Difficult placement

• Increased risk of stent migration and delayed bleeding (even for the possibility of GI tract injury)

Transmural endoscopic drainage with LAMSs

• Cystogastrostomy

• Cystoduodenostomy

• AXIOS™, 10-15-20 mm

(Boston Scientific, Marlborough, MA, USA)

• SPAXUS™, 8-10-16 mm

(Taewoong Medical, Gimpo, Korea)

• NAGI™, 10-16 mm

(Taewoong Medical, Gimpo, Korea)

• AixstentⓇ PPS, 10-15 mm (Leufen Medical, Berlin, Germany)

• Hanaro stentⓇ, 10 mm (Mi-TECH-Medical Co, Seoul, South Korea)

• Large caliber

• Easy placement, even without the need for wire exchange

• Easy removal

• Possibility to perform DEN through stent

• Lower risk of migration

• Reduced need for fluoroscopy and nasocystic drain placement

• Cost

• Increased risk of suprainfection and bleeding in the early phases (<14 days)

Transpapillary drainage via ERCP

• Major/minor duodenal papilla

Pancreatic endoprosthesis

5-7 Fr

• Active or passive drainage (with or without nasal drain)

• Evidence of pancreatic duct disruption

• Considered as an alternative when the distance from the GI wall to the PFC is too large (>10-15 mm)

• Limited use in WOPN with poorly-liquefied necrotic tissue

Percutaneous endoscopic necrosectomy

• Percutaneous approach

Esophageal, partially or fully-covered SEMS

18-20 mm

• Single or multiport gateway

• Possibility to perform DEN even if PFC is located distal from the GI tract

• Reduced need of deep sedation

• Preceded by the creation of cutaneous fistula by interventional radiologists

• Increased risk of peri-procedural bleeding