title: [The clinical practice and related reflections of staged step-up approach in the treatment of patients with severe acute pancreatitis].
abstract: Both new insights in the pathophysiology of severe acute pancreatitis (SAP) and upspringing related evidence-based supports prompt the staged step-up approach, which stress emphasis on minimal invasiveness and damage control, to be accepted and advocated by the majority of guidelines. For documented or suspected patients with infected pancreatic necrosis, an imaging-guided percutaneous catheter drainage or an endoscopic transluminal drainage should be initially performed followed by, if necessary, a minimal access retroperitoneal necrosectomy, or a video-assisted retroperitoneal debridement, or an endoscopic transluminal necrosectomy, or an even an open access necrosectomy. The outstanding performance of staged step-up approach in patients with SAP has been justified from both a clinical and a health economic point of view, meanwhile, there are some issues remained to be further elucidated and optimized.
authors.affiliation: Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China; Email: sunbei70@tom.com.
authors.forename: Bei
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ji
mesh_terms: D000208:Acute Disease; D003646:Debridement; D004322:Drainage; D004724:Endoscopy; D006801:Humans; D010195:Pancreatitis / Q000601:surgery*; D012187:Retroperitoneal Space; D016896:Treatment Outcome