Abstrakt

Around 20% of patients with acute pancreatitis develop necrosis of the pancreas or peripancreatic fat tissue with associated peripancreatic collections. Sterile necrosis can generally be managed conservatively and the mortality rate is relatively low. Approximately 30% of patients with necrotizing pancreatitis, however, develop secondary infection of peripancreatic collections (walled off necrosis – WON), which is associated with sepsis and organ failure and is an indication for intervention. Until 20 years the first-choice intervention in infected necrotizing pancreatitis has been surgical necrosectomy by laparotomy with the aim of removing all infected necrosis. This approach is associated with considerable morbidity and mortality. In the past 2 decades, several cohort studies on US- or CT-guided percutaneous drainage (PCD) and EUS-guided internal drainage with transluminal endoscopic necrosectomy have been published. Recently, a minimally invasive “step-up approach”, consisting of PCD followed by EUS-guided drainage and endoscopic necrosectomy if necessary, has proven to be more effective than primary open necrosectomy. Surgical treatment can be limited to cases where percutaneous guided drainage with endoscopic therapy fails.

Autoreninformation

Autoren

• S. Reichel
• U. Will

Abteilungen

• Klinik für Gastroenterologie, Hepatologie und Allgemeine Innere Medizin, SRH Waldklinikum Gera

Adresse

Prof. Dr. med. U. Will
Klinik für Gastroenterologie, Hepatologie und
Allgemeine Innere Medizin
SRH Waldklinikum Gera
Straße des Friedens 122
D–07548 Gera
Email: [email protected]

Citation