Minimally Invasive Management of Acute Necrotizing Pancreatitis

Abstract

About 10% to 20% of patients with acute pancreatitis develop severe disease, which is characterized by intrapancreatic or peripancreatic necrosis [1-6]. Necrotizing pancreatitis is the most severe form of acute pancreatitis associated with high morbidity and mortality due to the development of infected pancreatic necrosis, and multisystem organ failure. In severe necrotizing pancreatitis, the mortality rate ranges from 10% to 40%, and it is especially high (up to 50%) when the necrosis is infected and progressing to sepsis and multiorgan failure [1-3,7]. The appropriate treatment of infected pancreatic necrosis remains the subject of much debate. It is generally accepted that in infected necrotizing pancreatitis the infected non-vital solid tissue has to be removed in order to control the sepsis. For decades, open surgery and immediate surgical necrosectomy was the gold standard treatment for patients with infected pancreatic necrosis [1,3,7,8]. However, several reports have shown that early surgical intervention for pancreatic necrosis could result in a worse prognosis compared to cases where surgery is delayed or avoided [9-13]. It has been suggested that the invasiveness of open surgery in an already critically ill patient may be the cause of high morbidity rates. Therefore, several groups worldwide have developed new minimal invasive approaches using conservative treatment, endoscopic necrosectomy or drainage therapy in the management of infected necrotizing pancreatitis [14-19].