Pancreatitis sepsis: Evolution and principles in the management of necrotizing pancreatitis

Outcomes from some recent clinical trials have helped to improve the management of necrotizing pancreatitis over the last 2 decades. The location of the retroperitoneal collection, previous gastric surgery, patient preference, and medical expertise dictates a minimally invasive surgical step-up versus endoscopic approach. Endoscopic drainage is facilitated by either a plastic or metallic stent. Direct endoscopic necrosectomy is performed for lack of improvement after endoscopic drainage. The surgical approach is accomplished by minimally invasive surgery with either video-assisted retroperitoneal debridement or laparoscopic drainage. A multidisciplinary team with appropriate expertise should care for patients with necrotizing pancreatitis. This brief review summarizes the landmark clinical trials, compares the benefits and roles of endoscopic, surgical, and percutaneous interventions, and discusses treatment algorithms for necrotizing pancreatitis in the modern era.