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Treatment of Walled-Off Necrosis

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Walled-off necrosis is a well-recognized complication of necrotizing pancreatitis. While small necrotic collections may resolve spontaneously, larger collections that cause sepsis, luminal obstruction, or persistent unwellness require multidisciplinary care for optimal clinical outcomes. In general, minimally invasive strategies are preferred over more invasive approaches. Close clinical follow-up, medical management, and nutritional support are critical for all patients. While endoscopic transmural drainage with or without necrosectomy is the primary approach for patients requiring an intervention, for collections not amenable to endoscopic approach, video-assisted retroperitoneal debridement, or laparoscopic cystogastrostomy with internal debridement are other alternatives. Image-guided percutaneous drain placement acts as a temporizing measure or as bridge to surgery in very sick patients. More studies are required to refine existing procedural techniques in order to make treatment modalities more effective and less cumbersome.

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Author information

Authors and Affiliations

  1. Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL, USA

    Shyam Varadarajulu

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  1. Shyam Varadarajulu
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Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Gastrointestinal Endoscopy IRCCS, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Varadarajulu, S. (2022). Treatment of Walled-Off Necrosis. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-56993-8_96

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  • DOI: https://doi.org/10.1007/978-3-030-56993-8_96

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-56992-1

  • Online ISBN: 978-3-030-56993-8

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