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Review
. 2018 Dec 7;3(1):80-88.
doi: 10.1002/jgh3.12109. eCollection 2019 Feb.

Endotherapy for pancreatic necrosis: An update

Ashish K Jha  1 , Mahesh K Goenka  2 , Ramesh Kumar  3 , Arya Suchismita  4
Affiliations
Review

Endotherapy for pancreatic necrosis: An update

Ashish K Jha et al. JGH Open. .

Abstract

Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis. The presence of necrosis in a pancreatic collection significantly worsens the prognosis. Pancreatic necrosis is associated with high mortality and morbidity. In the last few decades, there has been a significant revolution in the treatment of infected pancreatic necrosis. A step-up approach has been proposed, from less invasive procedures to the operative intervention. Minimally invasive treatment modalities such as endoscopic drainage and necrosectomy, percutaneous drainage, and minimally invasive surgery have recently replaced open surgical necrosectomy as the first-line treatment option. Endoscopic intervention for pancreatic necrosis is being increasingly performed with good success and a lower complication rate. However, techniques of endotherapy are still not uniform and vary as per local expertise, and there are still many unresolved questions with regard to the interventions in patients with pancreatic necrosis. The objective of this paper is to critically review the literature and update the concepts of endoscopic interventional therapy of pancreatic necrosis.

Keywords: acute necrotizing pancreatitis; acute pancreatitis; direct endoscopic necrosectomy; endotherapy; minimal access retroperitoneal pancreatic necrosectomy; open necrosectomy; walled‐off pancreatic necrosis.

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Figures

Figure 1
Figure 1
Magnetic resonance imaging (T2W) image showing a large, thick‐walled heterogenous cystic lesion with internal hypointense solid necrotic material and hyperintense fluid component indenting the posterior gastric wall, suggestive of walled‐off pancreatic necrosis.
Figure 2
Figure 2
Images showing gastric bulge, access into the cavity, and coiling of guidewire into the cavity.
Figure 3
Figure 3
Images showing endoscopic drainage of walled‐off pancreatic necrosis with placement of two double‐pigtail plastic stents (cystoduodenostomy).
Figure 4
Figure 4
Images showing direct endoscopic necrosectomy of walled‐off pancreatic necrosis.
See this image and copyright information in PMC

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