Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3383
Peer-review started: January 20, 2022
First decision: February 24, 2022
Revised: March 7, 2022
Accepted: June 15, 2022
Article in press: June 15, 2022
Published online: July 21, 2022
Processing time: 179 Days and 5.6 Hours
Acute pancreatitis (AP) is one of the most common gastrointestinal diseases and remains a life-threatening condition. Although AP resolves to restitutio ad integrum in approximately 80% of patients, it can progress to necrotizing pancreatitis (NP). NP is associated with superinfection in a third of patients, leading to an increase in mortality rate of up to 40%. Accurate and early diagnosis of NP and associated complications, as well as state-of-the-art therapy are essential to improve patient prognoses. The emerging role of endoscopy and recent trials on multidisciplinary management of NP established the “step-up approach”. This approach starts with endoscopic interventions and can be escalated to other interventional and ultimately surgical procedures if required. Studies showed that this approach decreases the incidence of new multiple-organ failure as well as the risk of interventional complications. However, the optimal interventional sequence and timing of interventional procedures remain controversial. This review aims to summarize the indications, timing, and treatment outcomes for infected NP and to provide guidance on multidisciplinary decision-making.
Core Tip: Acute pancreatitis remains a potentially life-threatening disease. Necrotizing pancreatitis (NP) is associated with superinfection and increases the mortality rate. We summarized the current evidence and clinical recommendations of multidisciplinary approaches focusing on conservative, interventional, and surgical treatment. The interventional approach is often required as a first step in treating infected NP, while further options include minimal invasive or an escalation to open surgical treatment. Although this “step-up approach” is well-established, the exact timing, sequence, and procedure choice remain controversial; this review aims to summarize current evidence and to provide guidance for decision making in clinical practice.