title: Treatment of necrotizing pancreatitis.
abstract: Acute pancreatitis is a common and potentially lethal disease. It is associated with significant morbidity and consumes enormous health care resources. Over the last 2 decades, the treatment of acute pancreatitis has undergone fundamental changes based on new conceptual insights and evidence from clinical studies. The majority of patients with necrotizing pancreatitis have sterile necrosis, which can be successfully treated conservatively. Emphasis of conservative treatment is on supportive measures and prevention of infection of necrosis and other complications. Patients with infected necrosis generally need to undergo an intervention, which has shifted from primary open necrosectomy in an early disease stage to a step-up approach, starting with catheter drainage if needed, followed by minimally invasive surgical or endoscopic necrosectomy once peripancreatic collections have sufficiently demarcated. This review provides an overview of current standards for conservative and invasive treatment of necrotizing pancreatitis.
authors.affiliation: Department of Operating Theatres and Evidence-Based Surgery, Radboud University Nijmegen Medical Center, Nijmegen.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Brunschot
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
mesh_terms: D003141:Communicable Diseases / Q000188:drug therapy; D004322:Drainage; D004724:Endoscopy; D006801:Humans; D017053:Infection Control / Q000379:methods; D010179:Pancreas / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*