Akut Pankreatitte Endoskopik Tedavi
Özet
Akut pankreatit (AP), gastrointestinal sistem hastalıkları arasında en sık hastaneye yatış gerektiren patolojidir ve vakaların %20'sinde nekrotizan pankreatit gibi ciddi tablolar gelişebilmektedir. Bu durumun tedavisinde teknolojik gelişmelerle birlikte endoskopik yöntemler cerrahi girişimlerin yerini almaya başlamıştır. AP tanılı hastalarda endoskopik süreçler temel olarak safra taşına bağlı vakalarda ERCP ile kanal temizliği ve beslenme için enteral tüp yerleştirilmesiyle sınırlıdır. Hastalığın seyrinde gelişen peripankreatik sıvı koleksiyonları, pseudokistler ve duvarlanmış pankreatik nekroz (WON) gibi lokal komplikasyonların tedavisinde endoskopik drenaj yöntemleri kritik rol oynar. Pseudokistlerin drenajı transpapiller veya EUS eşliğinde transmural olarak gerçekleştirilirken; WON vakalarında daha kompleks olan direkt endoskopik nekrozektomi teknikleri (LAMS veya plastik stentler ile) uygulanmaktadır. Bu işlemler başarılı sonuçlar verse de kanama, perforasyon ve hava embolisi gibi ciddi riskler taşıdığından deneyimli merkezlerde yapılması önerilir.
Acute pancreatitis (AP) is the most common pathology requiring hospital admission among gastrointestinal diseases, with approximately 20% of cases progressing to necrotizing pancreatitis. Due to technological advancements, endoscopic interventions are increasingly replacing surgical procedures in managing local complications. In patients diagnosed with AP, primary endoscopic treatments include endoscopic retrograde cholangiopancreatography (ERCP) for biliary pancreatitis and the placement of enteral feeding tubes. Endoscopic drainage plays a vital role in treating local complications such as peripancreatic fluid collections, pseudocysts, and walled-off pancreatic necrosis (WON). While pseudocyst drainage is performed via transpapillary or EUS-guided transmural routes, WON requires more complex direct endoscopic necrosectomy techniques using LAMS or plastic stents. Although these procedures yield high success rates, they carry risks like bleeding, perforation, and air embolism; therefore, they should be performed by experienced specialists in specialized centers.
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