Percutaneous management of necrotizing pancreatitis

The management algorithm surrounding necrotizing pancreatitis has altered radically in the last 15 years in response to evolving concepts, improved understanding and the development of minimally invasive techniques, including percutaneous necrosectomy, and laparoscopic or EUS-guided cystgastrostomy. This article discusses the emerging role of minimally invasive techniques, key to which is an understanding of the evolving pathology of post acute, necrosis-associated fluid collections in pancreatitis. A dynamic and multi-modal management approach is presented, the aim of intervention being the 'adequate and maintained control of sepsis': the choice of technique dependent on the anatomical position, the ratio of solid to fluid components within the collection, and in particular the degree of systemic organ dysfunction.