Minimally invasive intervention for infected necrosis in acute pancreatitis

Abstract

Infected necrosis is the main indication for invasive intervention in acute necrotizing pancreatitis. The 2013 IAP/APA guidelines state that percutaneous catheter drainage should be the first step in the treatment of infected necrosis. In 50–65% of patients, additional necrosectomy is required after catheter drainage, which was traditionally done by open necrosectomy. Driven by the perceived lower complication rate, there is an increasing trend toward minimally invasive percutaneous and endoscopic transluminal necrosectomy. The authors present an overview of current minimally invasive treatment options for necrotizing pancreatitis and review recent developments in clinical studies.

Keywords::

• acute pancreatitis
• drainage
• endoscopic
• laparoscopy
• minimally invasive
• necrosectomy
• necrotizing pancreatitis
• surgery
• VARD

Financial & competing interests disclosure

RA Hollemans has received a PhD grant from the Maag Lever Darm Stichting (MLDS) with the Dutch Pancreatitis Study Group, Department of Surgery, University Medical Center Utrecht. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Sterile asymptomatic necrotizing pancreatitis can be treated non-invasively.

• Necrosectomy is best postponed until necrosis is walled off.

• Catheter drainage should be the first step in the treatment of infected necrosis.

• Minimally invasive necrosectomy seems superior to open necrosectomy in terms of complications and resource utilization.

• The 2013 evidence-based IAP/APA guidelines reflect the increasing international consensus on the treatment of acute pancreatitis.

Notes