**Abstract**

Acute pancreatitis is an acute clinical condition where it can be manifested as mild disease or serious and life-threatening condition. There are several factors that may be responsible for this condition, such as genetic, gallstone disease, alcohol consumption, pancreatic trauma, medication, hypertriglyceridemia, autoimmune disease, and surgery. The most common manifestation of pancreatic parenchymal injury is pancreatic pseudocyst (PPC) formation, where peripancreatic fluid collection (PFCs) usually precedes this condition. Even though most of the pseudocyst can be managed conservatively, however in conditions such as infected pseudocyst or possible wall of necrosis (WON), there should be an early intervention management. Clinical evaluation and imaging studies have to be done in the beginning. Computed tomography (CT) scan or magnetic resonance imaging (MRI) are the main imaging techniques used to evaluate the characteristic of the cyst, the size, surrounding vascularity, and to assess the pancreatic duct itself with possible of fistula formation. Clinical conditions that are usually considered for early intervention management are symptomatic pseudocyst, large size of pseudocyst, presence of gastric outlet obstruction, or biliary obstruction. PFC should be evaluated as it has been classified based on type of pancreatitis, time frame, well-defined wall, and debris contained inside the cyst. Endoscopic management has replaced percutaneous and surgical approach in most of PFC cases. Nowadays, endoscopic ultrasound (EUS) has been widely used as the first-line tool for PFC drainage procedure. Pancreatic pseudocyst stenting is the most common procedure in most of the centers in the world. However, the cost, availability, and expertise are needed to be considered in clinical practice.

**Keywords:** endoscopic management, pancreatic fluid collections, acute pancreatitis

## **1. Introduction**

Acute pancreatitis is one of the challenging situations in clinical practice where it can lead to a critical condition. This condition also needs to be carefully managed to prevent more complications [1]. One of the major complications is acute peripancreatic fluid collections (APPFC) and pseudocyst development [2, 3]. The clinical

**Figure 1.** *Patient with infected pancreatic pseudocyst and acute pancreatitis [6].*

decision for pancreatic pseudocyst or necrotic infected cyst drainage procedure is very important with regard to the patient's clinical condition and imaging evaluation. There are several well-known routes of drainage procedure of choice such as percutaneous, endoscopic, or surgical drainage [4].

Recently, development of therapeutic endoscopic ultrasound (EUS) procedure has become more popular in most of the highly experienced centers as a first-line management in pancreatic fluid collection drainage [5–7] (**Figure 1**). However, it would need a good comprehensive team work and facilities to perform this kind of procedure.
