Pancreatic fluid collection often occurs as a local complication of acute pancreatitis, and drainage is indicated in symptomatic patients. The drainage may be surgical, percutaneous, or endoscopic ultrasound (EUS) guided. In symptomatic collections older than 4 weeks and localized in the upper abdomen, EUS-guided drainage is the first choice of treatment. Lumen-apposing metal stents are useful in cases of walled-off necrosis, facilitating access to the cavity; however, they do not reduce the number of necrosectomy sessions required. In most pancreatic pseudocysts requiring drainage, plastic stents remain the first choice of treatment. This review aimed to summarize the principles and techniques of step-up therapy of pancreatic fluid collections, including preprocedural and postprocedural assessment and practical approaches of drainage and necrosectomy, making available evidence more accessible to endoscopists aiming to train for this procedure. Successful and safe EUS drainage connotes early recognition and treatment of complications and the presence of a multidisciplinary team for optimal patient management. However, the best time for necrosectomy, modality of drainage method (lumen-apposing metal stents or plastic stents), and duration of antibiotherapy are still under evaluation.

中文翻译：

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内镜超声引流胰腺积液：我们对最佳方法了解足够吗？

胰腺积液通常是急性胰腺炎的局部并发症，有症状的患者需要引流。引流可以通过手术、经皮或超声内镜 (EUS) 引导。对于超过 4 周且位于上腹部的症状性收集，EUS 引导引流是首选治疗方法。内腔金属支架在封闭性坏死的情况下很有用，有助于进入空腔；然而，它们并没有减少所需的坏死切除术次数。对于大多数需要引流的胰腺假性囊肿，塑料支架仍然是首选治疗方法。本综述旨在总结胰液收集升级治疗的原则和技术，包括术前和术后评估以及引流和坏死切除的实用方法，使旨在培训该手术的内窥镜医师更容易获得现有证据。成功且安全的 EUS 引流意味着早期识别和治疗并发症，以及多学科团队的存在以实现最佳的患者管理。然而，坏死组织切除的最佳时机、引流方式（管腔金属支架或塑料支架）以及抗生素治疗的持续时间仍在评估中。