Endoscopic management of pancreatic fluid collections: New technology and techniques

Endoscopic ultrasound–guided drainage of pancreatic fluid collections has become a frontier for minimally invasive endoscopic interventions, which should be compared with the gold-standard drainage procedure, and its clinical resolution should be compared with that of invasive surgery and interventional radiological techniques. The major limitations of endoscopic ultrasound–guided interventions have been difficult multistep access procedures, incomplete drainage requiring rescue surgical drainage, and infrequent, but significant, complications. This review will address recent advances including forward-viewing echoendoscope technology, custom-designed access tools, improved drainage techniques, and modified fully covered self-expandable stents, which when integrated into these complex interventions can achieve excellent immediate technical success and high complete clinical resolution of a spectrum of pancreatic fluid collections including walled-off pancreatic necrosis and abscesses.