TABLE 1.

Main recommendations

1. Treatment (both conservative and, in the case of no improvement, interventional) of postinflammatory pancreatic and peripancreatic fluid collections is indicated only in patients with collection­‑related clinical symptoms.

2. Interventional treatment of symptomatic postinflammatory pancreatic and peripancreatic fluid collections should be deferred until collection encapsulation, and in the collections due to necrotizing AP, until collection content liquefaction, which usually occurs 4 weeks after the disease onset.

3. For early symptomatic fluid collections developing during the first 4 weeks of pancreatitis, the recommended management is watchful waiting, possibly with conservative treatment.

4. For symptomatic postinflammatory pancreatic and peripancreatic fluid collections demonstrating no clinical improvement following conservative treatment, interventional treatment should be initiated using minimally­‑invasive techniques that facilitate access to the fluid collections via a transmural, transpapillary, extraperitoneal, or transperitoneal route. Surgery remains the treatment of choice only if minimally-invasive methods prove ineffective.

5. Regardless of the access route to the collection, the cornerstone of treatment of postinflammatory pancreatic and peripancreatic fluid collections is the establishment of an effective drainage system

6. The mainstay of endoscopic treatment of postinflammatory pancreatic and peripancreatic fluid collections is EUS­‑guided transmural drainage.

7. For WOPN collections, stepping up of the endoscopic treatment via endoscopic necrosectomy may be required.

8. In patients with postinflammatory pancreatic and peripancreatic fluid collections presenting with no clinical improvement, an additional access route to the collection using other interventional treatment techniques may be necessary in addition to endoscopic treatment intensification

9. Endoscopic treatment of postinflammatory pancreatic and peripancreatic fluid collections can be terminated after treatment success is acknowledged, at which time, the transmural / transpapillary stents can be removed, and the transmural / transpapillary endoscopic drainage can be completed.

10. Most complications of postinflammatory pancreatic and peripancreatic fluid collection endotherapy can be successfully treated using conservative or endoscopic means. However, in some cases, especially in hemorrhagic complications, interventional radiology or vascular surgery techniques, or conventional surgical treatment may be necessary, depending on the experience of the treating center.

11. If treatment of postinflammatory pancreatic and peripancreatic fluid collections fails despite intensified interventional treatment using minimally­‑invasive techniques, surgical treatment remains the treatment of choice.

12. For recurrent postinflammatory pancreatic and peripancreatic fluid collections, endoscopic treatment may be repeated postendotherapy

Abbreviations: AP, acute pancreatitis; EUS, endoscopic ultrasound; WOPN, walled-off pancreatic necrosis