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Review
. 2017 Jul;50(4):357-365.
doi: 10.5946/ce.2016.152. Epub 2017 May 16.

Necrotizing Pancreatitis: Current Management and Therapies

Christine Boumitri  1 , Elizabeth Brown  2 , Michel Kahaleh  2
Affiliations
Review

Necrotizing Pancreatitis: Current Management and Therapies

Christine Boumitri et al. Clin Endosc. 2017 Jul.

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.

Keywords: Necrosis; Pancreatitis; Pseudocyst; Walled-off pancreatic necrosis.

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Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Large retrogastric pancreatic fluid collection on magnetic resonance imaging.
Fig. 2.
Fig. 2.
Large necrotic debris visualized during endoscopic necrosectomy.
Fig. 3.
Fig. 3.
Computed tomography (CT) image of abdomen showing a transgastric lumen apposing metal stent placed into a walled off necrosis (patient A).
Fig. 4.
Fig. 4.
Endoscopic view of removal of necrosis though the lumen apposing metal stent.
Fig. 5.
Fig. 5.
Endoscopic view of the extraction of necrosis from the necrotic cavity with deposition into the stomach.
Fig. 6.
Fig. 6.
Endoscopic vision of a necrotic cavity post debridement.
Fig. 7.
Fig. 7.
Computed tomography (CT) image of abdomen showing resolution of walled off necrosis (patient A).
Fig. 8.
Fig. 8.
Management algorithm of pancreatic fluid collection. ERCP, endoscopic retrograde cholangiopancreatography; PD, pancreatic duct; EUS, endoscopic ultrasound.
See this image and copyright information in PMC

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