Defying the Guidelines: Early Endoscopic Drainage of Pancreatic Necrosis

Critically ill patients with pancreatic necrosis who cannot wait the standard 4 weeks for endoscopic drainage and debridement should be considered for earlier treatment.

Usually, endoscopic drainage is delayed for at least 4 weeks following the onset of pancreatic necrosis (with many centers waiting longer if possible). This delay is thought to allow maturation of the necrotic collection and its surrounding wall, improve adherence of the collection to the stomach or duodenum, and has been associated with better clinical outcomes. A recent study evaluated treatment performed sooner than 4 weeks after onset.

The authors retrospectively analyzed pancreatic necrosis treatment delivered via a step-up approach; transluminal drainage was the primary modality, with or without necrosectomy, and/or percutaneous catheter placement as needed. Surgery was reserved for treatment failure.

Of 193 patients analyzed, 76 underw…

Reviewing Author

Douglas G. Adler, MD, FACG, AGAF, FASGE

Disclosures

Consultant/Advisory BoardBSC; Merit; Olympus

Speaker’s BureauAbbVie

Editorial BoardsGastrointestinal Endoscopy

Douglas G. Adler, MD, FACG, AGAF, FASGE

Disclosures

Consultant/Advisory BoardBSC; Merit; Olympus

Speaker’s BureauAbbVie

Editorial BoardsGastrointestinal Endoscopy

Defying the Guidelines: Early Endoscopic Drainage of Pancreatic Necrosis

Topics

Reviewing Author