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Infected pancreatic necrosis—Current trends in management

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Abstract

Acute necrotizing pancreatitis is a common gastrointestinal disease requiring hospitalization and multiple interventions resulting in higher morbidity and mortality. Development of infection in such necrotic tissue is one of the sentinel events in natural history of necrotizing pancreatitis. Infected necrosis develops in around 1/3rd of patients with necrotizing pancreatitis resulting in higher mortality. So, timely diagnosis of infected necrosis using clinical, laboratory and radiological parameters is of utmost importance. Though initial conservative management with antibiotics and organ support system is effective in some patients, a majority of patients still requires drainage of the collection by various modalities. Mode of drainage of infected pancreatic necrosis depends on various factors such as the clinical status of the patient, location and characteristics of collection and availability of the expertise and includes endoscopic, percutaneous and minimally invasive or open surgical approaches. Endoscopic drainage has proved to be a game changer in the management of infected pancreatic necrosis in the last decade with rapid evolution in procedure techniques, development of novel metal stent and dedicated necrosectomy devices for better clinical outcome. Despite widespread adoption of endoscopic transluminal drainage of pancreatic necrosis with excellent clinical outcomes, peripheral collections are still not amenable for endoscopic drainage and in such scenario, the role of percutaneous catheter drainage or minimally invasive surgical necrosectomy cannot be understated. In a nutshell, the management of patients with infected pancreatic necrosis involves a multi-disciplinary team including a gastroenterologist, an intensivist, an interventional radiologist and a surgeon for optimum clinical outcomes.

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Authors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Jimil Shah

  2. Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB, Université Libre de Bruxelles, Brussels, Belgium

    Michael Fernandez Y Viesca & Marianna Arvanitakis

  3. Department of Gastroenterology, Tivoli Hospital, La Louviere, Belgium

    Robert Jagodzinski

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JS, MA: concept of study, drafting manuscript, critically revising the manuscript. MFYV, RJ: drafting manuscript, critically revising the manuscript, Final approval of manuscript: all authors.

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Correspondence to Marianna Arvanitakis.

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Shah, J., Fernandez Y Viesca, M., Jagodzinski, R. et al. Infected pancreatic necrosis—Current trends in management. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-023-01506-w

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