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KMID : 0985520130180020031
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Korean Journal of Pancreas and Biliary Tract
2013 Volume.18 No. 2 p.31 ~ p.41
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Clinical Practice Guideline for Acute Pancreatitis: The Treatment of Local Complication of Acute Pancreatitis and Necrotizing Pancreatitis
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Kim Tae-Hyeon
Seo Dong-Wan
Lee Seong-Ok
Kim Seong-Hun
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Abstract
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Acute pancreatitis is a common and potentially lethal disease. It is associated with significant morbidity and consumes enormous health care resources. Over the last two decades, the treatment of acute pancreatitis has undergone fundamental changes based on new conceptual insights and evidence from clinical studies. The majority of patients with necrotizing pancreatitis have sterile necrosis, which can be successfully treated conservatively. Patients with infected necrosis generally need to undergo an intervention which should ideally be delayed as long as possible, preferably 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Intervention has shifted from primary open necrosectomy in an early disease stage to a step-up approach, starting with catheter drainage, if needed followed by minimally invasive surgical or endoscopic necrosectomy. Interventional treatment such as percutaneous drainage or endoscopic drainage or surgery should be performed for pancreatic pseudocysts that give rise to symptoms and accompany complications. Applicability of these techniques depends on the availability of specialized expertise and a multidisciplinary team dedicated to the management of severe acute pancreatitis and its complications. This guideline review provides an overview of current standards for conservative and invasive treatment of necrotizing pancreatitis and its local complication such as pseudocyst and abscess.
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KEYWORD
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necrotizing pancreatitis, sterile pancreatic necrosis, infected pancreatic necrosis, pancreatic pseudocyst, pancreatic abscess
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