November 12, 2014
Notes: Cui, Mei Lan
Kim, Kook Hyun
Kim, Ho Gak
Cho, Kwang Bum
Jung, Min Kyu
Cho, Chang Min
Kim, Tae Nyeun
Research Support, Non-U.S. Gov’t
Dig Dis Sci. 2014 May;59(5):1055-62. doi: 10.1007/s10620-013-2967-4. Epub 2013 Dec 11.
Author Address: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1 Daemyung 5-dong Nam-gu, Taegu, 705-717, Korea, firstname.lastname@example.org.
Reference Type: Journal Article
Record Number: 4638Author: da Costa, D. W., Boerma, D., van Santvoort, H. C., Horvath, K. D., Werner, J., Carter, C. R., Bollen, T. L., Gooszen, H. G., Besselink, M. G. and Bakker, O. J.
Title: Staged multidisciplinary step-up management for necrotizing pancreatitis
Journal: Br J Surg
Short Title: Staged multidisciplinary step-up management for necrotizing pancreatitis
Alternate Journal: The British journal of surgery
ISSN: 1365-2168 (Electronic)
Accession Number: 24272964
Keywords: Antibiotic Prophylaxis/methods
Pancreatitis, Acute Necrotizing/diagnosis/*therapy
Patient Care Team/organization & administration
Severity of Illness Index
Abstract: BACKGROUND: Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services. METHODS: This review summarizes the latest insights into the surgical and medical management of necrotizing pancreatitis. General management strategies for the treatment of complications are discussed in relation to the stage of the disease. RESULTS: Frequent clinical evaluation of the patient’s condition remains paramount in the first 24-72 h of the disease. Liberal goal-directed fluid resuscitation and early enteral nutrition should be provided. Urgent endoscopic retrograde cholangiopancreatography is indicated when cholangitis is suspected, but it is unclear whether this is appropriate in patients with predicted severe biliary pancreatitis without cholangitis. Antibiotic prophylaxis does not prevent infection of necrosis and antibiotics are not indicated as part of initial management. Bacteriologically confirmed infections should receive targeted antibiotics. With the more conservative approach to necrotizing pancreatitis currently advocated, fine-needle aspiration culture of pancreatic or extrapancreatic necrosis will less often lead to a change in management and is therefore indicated less frequently. Optimal treatment of infected necrotizing pancreatitis consists of a staged multidisciplinary ‘step-up’ approach. The initial step is drainage, either percutaneous or transluminal, followed by surgical or endoscopic transluminal debridement only if needed. Debridement is delayed until the acute necrotic collection has become ‘walled-off’. CONCLUSION: Outcome following necrotizing pancreatitis has improved substantially in recent years as a result of a shift from early surgical debridement to a staged, minimally invasive, multidisciplinary, step-up approach.