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The management of pancreatic necrosis has shifted to minimally invasive techniques like endoscopic drainage. A step-up approach, starting with less invasive methods, is recommended for better outcomes in pancreatic necrosis treatment.

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Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Surgical Oncology

Background:

  • Pancreatic necrosis management has evolved from open surgery to minimally invasive approaches.
  • A step-up strategy, prioritizing less invasive interventions, is now standard.
  • Distinguishing between pseudocysts and walled-off necrosis (WON) is crucial for appropriate treatment.

Purpose of the Study:

  • To review the current paradigm shift in pancreatic necrosis management.
  • To highlight the efficacy of minimally invasive techniques.
  • To discuss the role of endoscopic interventions and surgical options.

Main Methods:

  • Review of current literature on pancreatic necrosis management.
  • Emphasis on minimally invasive techniques: interventional radiology, laparoscopy, and endoscopy.
  • Discussion of step-up approach and timing of interventions (minimum 4 weeks for encapsulation).

Main Results:

  • Minimally invasive techniques (endoscopic, laparoscopic, radiologic) are preferred over open surgery.
  • Direct endoscopic necrosectomy (DEN) and dual-modality drainage show promise.
  • Minimally invasive surgical options offer alternatives to open necrosectomy.

Conclusions:

  • An algorithmic, multidisciplinary approach is essential for managing pancreatic necrosis.
  • Minimally invasive strategies, including endoscopic interventions, are effective.
  • Disconnected pancreatic duct syndrome requires tailored long-term management strategies.