Clin Endosc.  2017 Jul;50(4):357-365. 10.5946/ce.2016.152.

Necrotizing Pancreatitis: Current Management and Therapies

• Boumitri C
• Brown E
• Kahaleh M

• KMID: 2389241
• DOI: http://doi.org/10.5946/ce.2016.152

Abstract

Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. In this review, we summarize the current management and therapies for acute necrotizing pancreatitis.

Keyword

Walled-off pancreatic necrosis; Pseudocyst; Pancreatitis; Necrosis

MeSH Terms

Drainage
Mortality
Necrosis
Pancreatitis*
Pancreatitis, Acute Necrotizing

Figure

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  Fig. 1. Large retrogastric pancreatic fluid collection on magnetic resonance imaging.

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  Fig. 2. Large necrotic debris visualized during endoscopic necrosectomy.

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  Fig. 3. Computed tomography (CT) image of abdomen showing a transgastric lumen apposing metal stent placed into a walled off necrosis (patient A).

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  Fig. 4. Endoscopic view of removal of necrosis though the lumen apposing metal stent.

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  Fig. 5. Endoscopic view of the extraction of necrosis from the necrotic cavity with deposition into the stomach.

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  Fig. 6. Endoscopic vision of a necrotic cavity post debridement.

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  Fig. 7. Computed tomography (CT) image of abdomen showing resolution of walled off necrosis (patient A).

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  Fig. 8. Management algorithm of pancreatic fluid collection. ERCP, endoscopic retrograde cholangiopancreatography; PD, pancreatic duct; EUS, endoscopic ultrasound.

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