From the Guidelines
The hospital treatment for necrotizing pancreatitis typically involves a step-up approach, starting with percutaneous drainage as the first line of treatment, which can delay the need for surgical intervention or even result in complete resolution of infection in 25-60% of patients 1.
Key Considerations
- Percutaneous drainage is recommended as the first line of treatment for infected pancreatic necrosis, as it allows for delaying surgical intervention to a more favorable time or potentially avoiding it altogether 1.
- Minimally invasive surgical strategies, such as transgastric endoscopic necrosectomy or video-assisted retroperitoneal debridement (VARD), can result in less postoperative new-onset organ failure, but may require more interventions 1.
- A multidisciplinary approach is essential in individualizing surgical treatment, taking into account local expertise and patient-specific factors 1.
- Surgical debridement is crucial in the management of necrotizing pancreatitis, with various techniques available, including open surgery, mini-invasive surgery, and endoscopic surgery 1.
Treatment Approach
- Clinical deterioration with signs or strong suspicion of infected necrotizing pancreatitis is an indication for intervention, such as percutaneous or endoscopic drainage 1.
- Walled-off necrotic collections or pseudocysts may require intervention if they cause symptoms or mechanical obstruction and do not resolve with inflammation 1.
- Disconnected pancreatic duct syndrome is an indication for intervention, such as a step-up approach starting with percutaneous or endoscopic drainage 1.
From the Research
Hospital Treatment for Necrotizing Pancreatitis
The hospital treatment for necrotizing pancreatitis involves various approaches, including:
- Medical treatment only: This approach is used for select patients and involves supportive measures and prevention of infection of necrosis and other complications 2.
- Percutaneous drainage: This is a minimally invasive technique that involves the insertion of catheters to drain fluid collections, and has been shown to be effective in managing infected necrotizing pancreatitis (INP) 3.
- Endoscopic debridement: This approach involves the use of endoscopy to remove necrotic tissue and has been used in combination with other therapies to manage necrotizing pancreatitis 4.
- Surgical treatment: This approach is used for patients who require definitive management of pancreatic necrosis and may involve open necrosectomy or minimally invasive surgical techniques 5, 6.
- Combination treatment: This approach involves the use of multiple therapies, such as medical treatment, percutaneous drainage, endoscopic debridement, and surgical treatment, to manage necrotizing pancreatitis 4, 6.
Minimally Invasive Techniques
Minimally invasive techniques, such as percutaneous drainage and endoscopic debridement, have become increasingly popular in the treatment of necrotizing pancreatitis due to their ability to reduce morbidity and mortality rates compared to open necrosectomy 6, 3. These techniques are often used in a step-up approach, where the least invasive method is used first and more invasive methods are added as needed 2, 3.
Step-Up Approach
The step-up approach involves the use of a minimally invasive technique, such as catheter drainage, as the initial treatment, followed by more invasive methods, such as surgical or endoscopic necrosectomy, if necessary 2, 6. This approach has been shown to be effective in reducing complications and improving patient outcomes 6, 3.