Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, Khetpal N, Ahmad S. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg 2019; 11(4): 198-217 [PMID: 31123558 DOI: 10.4240/wjgs.v11.i4.198]
Corresponding Author of This Article
Mamoon Ur Rashid, MBBS, MD, Doctor, Medical Resident, Department of Internal Medicine, Advent Health Graduate Medical Education, 2501 North Orange Avenue, Orlando, FL 32804, United States. mamoon.rashid.md@adventhealth.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2019; 11(4): 198-217 Published online Apr 27, 2019. doi: 10.4240/wjgs.v11.i4.198
Pancreatic necrosis: Complications and changing trend of treatment
Mamoon Ur Rashid, Ishtiaq Hussain, Sundas Jehanzeb, Waqas Ullah, Saeed Ali, Akriti Gupta Jain, Neelam Khetpal, Sarfraz Ahmad
Mamoon Ur Rashid, Saeed Ali, Akriti Gupta Jain, Neelam Khetpal, Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
Ishtiaq Hussain, Sundas Jehanzeb, Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
Waqas Ullah, Internal Medicine, Abington Hospital, Abington, PA 19001, United States
Sarfraz Ahmad, Department of Gynecologic Oncology, Advent Health Cancer Institute, Orlando, FL 32804, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mamoon Ur Rashid, MBBS, MD, Doctor, Medical Resident, Department of Internal Medicine, Advent Health Graduate Medical Education, 2501 North Orange Avenue, Orlando, FL 32804, United States. mamoon.rashid.md@adventhealth.com
Telephone: +1-407-3122766 Fax: +1-407-3032435
Received: March 12, 2019 Peer-review started: March 15, 2019 First decision: April 13, 2019 Revised: April 19, 2019 Accepted: April 23, 2019 Article in press: April 23, 2019 Published online: April 27, 2019 Processing time: 46 Days and 7 Hours
Abstract
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.
Core tip: Pancreatic necrosis is one of the serious complications of acute pancreatitis. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions which include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage which are discussed in detail in this review article. However, no single modality is optimal for the treatment, and a multi-modal approach is needed. The mainstay of the management is now shifting to a “Step-up approach” from the most non-invasive towards the most invasive techniques in a step-up manner as the indications arise.
