title: Timing of catheter drainage in infected necrotizing pancreatitis.
abstract: Acute pancreatitis is the most common gastrointestinal indication for hospital admission, and infected pancreatic and/or extrapancreatic necrosis is a potentially lethal complication. Current standard treatment of infected necrosis is a step-up approach, consisting of catheter drainage followed, if necessary, by minimally invasive necrosectomy. International guidelines recommend postponing catheter drainage until the stage of 'walled-off necrosis' has been reached, a process that typically takes 4 weeks after onset of acute pancreatitis. This recommendation stems from the era of primary surgical necrosectomy. However, postponement of catheter drainage might not be necessary, and earlier detection and subsequent earlier drainage of infected necrosis could improve outcome. Strong data and consensus among international expert pancreatologists are lacking. Future clinical, preferably randomized, studies should focus on timing of catheter drainage in patients with infected necrotizing pancreatitis. In this Perspectives, we discuss challenges in the invasive treatment of patients with infected necrotizing pancreatitis, focusing on timing of catheter drainage.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: van Grinsven
authors.affiliation: Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Department of Surgery, Maastricht University Medical Center and NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 5800, 6200 AZ Maastricht, Netherlands.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Dejong
authors.affiliation: Department of Surgery, Erasmus Medical Center, University of Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands.
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000465:Algorithms; D002404:Catheterization / Q000379:methods; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods; D005544:Forecasting; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors