Interpretation of American Gastroenterological Association Clinical Practice update: management of pancreatic necrosis in acute pancreatitis patients
10.19538/j.cjps.issn1005-2208.2019.12.04
- Author:
Lin GAO
1
;
Zhi-hui TONG
1
;
Wei-qin LI
1
Author Information
1. Medical School of Nanjing University,Severe Acute Pancreatitis Treatment Center, General Hospital of Eastern Theater Command Nanjing 210002, China
- Publication Type:Journal Article
- Keywords:
pancreatic necrosis;
step-up approach;
endoscopic necrosectomy;
minimally invasive surgery
- From:
Chinese Journal of Practical Surgery
2019;39(12):1257-1264
- CountryChina
- Language:Chinese
-
Abstract:
American Gastroenterological Association(AGA)has published the latest clinical practice update in Gastroenterology in August 2019. The purpose of this AGA clinical practice update is to review the available evidence and expert recommendations regarding the clinical care of patients with pancreatic necrosis and to offer concise best practice advice for the optimal management of patients with this highly morbid condition. In recent decades,with the improvement in clinical practice,the management of pancreatic necrosis in patients with acute pancreatitis(AP)has undergone great changes. The well-defined step-up approach has been more advocated rather than the traditional open surgery. The treatment of pancreatic necrosis mainly includes two aspects,conservative methods, which consist of antimicrobial therapy as well as nutrition support,and invasive interventions.Drainage and/or debridement of pancreatic necrosis is best indicated in patients with infected necrosis or patients with sterile pancreatic necrosis and persistent clinical symptoms,which need proactive management. A step-up approach consists of percutaneous drainage or endoscopic transmural drainage, followed by direct endoscopic/percutaneous minimally invasive necrosectomy, and then surgical debridement is reasonable. As for the comparison between percutaneous surgical or endoscopic step-up approach,no studies have shown that there are differences between the two in the main clinical outcomes,for instance,mortality. Hence,the choice of specific treatment strategy in different AP centers depends mainly on their available clinical expertise and medical resources.
