[THE MULTIDISCIPLINARY APPROACH TO ACUTE NECROTIZING PANCREATITIS]
Einat Ritter1, Oren Shibolet1, Rivka Kessner2
1Department of Gastroenterology and Hepatology , Tel Aviv Sourasky Medical Center, the Sackler Faculty of Medicine , Tel Aviv, Israel.
Harefuah
|March 20, 2024
Summary
Severe acute pancreatitis requires prompt intervention. Combining endoscopic and percutaneous drainage, followed by endoscopic necrosectomy if needed, improves outcomes for patients with pancreatic necrosis.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Endoscopy
- Radiology
Context:
- Acute pancreatitis is a common gastrointestinal disease, often leading to hospitalization and significant morbidity.
- While often self-limiting, up to 20% of cases progress to severe necrotizing pancreatitis, associated with high mortality.
- Management of severe cases involves addressing infected pancreatic fluid collections (PFCs) and potential mass effect.
Purpose:
- To outline the current management strategies for severe acute necrotizing pancreatitis.
- To emphasize the role of minimally invasive interventions in managing pancreatic fluid collections.
- To highlight the importance of a multidisciplinary approach for optimal patient outcomes.
Summary:
- Conservative management includes fluid resuscitation, nutritional support, and antibiotics for infected PFCs.
- Endoscopic ultrasound (EUS)-guided drainage is favored for PFCs; percutaneous drainage is used for larger or extended collections.
- Dual-modality drainage (endoscopic and percutaneous) reduces complications and hospitalization. Direct endoscopic necrosectomy is reserved for refractory cases.
Impact:
- Optimized management of severe acute pancreatitis can reduce multi-organ failure and mortality rates.
- Minimally invasive techniques, particularly dual-modality drainage, lead to better patient outcomes, including fewer complications and shorter hospital stays.
- A collaborative, multidisciplinary team approach is crucial for effectively managing complex cases of necrotizing pancreatitis.
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