Pancreatic necrosis: a scoping review.

IF 1.9 Q3 GASTROENTEROLOGY & HEPATOLOGY Minerva gastroenterology Pub Date : 2024-10-31 DOI:10.23736/S2724-5985.24.03658-1
Anthony Rainho, Mira Sridharan, Daniel S Strand
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Abstract

Acute pancreatitis (AP) is a commonly encountered GI diagnosis, accounting for 275,000 hospital admissions annually in the United States alone. Pancreatic necrosis (PN) is the most common complication of AP, and the development of PN is associated with significant morbidity and increased mortality. This expert review evaluates the evidence-based management of symptomatic PN from the era of maximal open pancreatic necrosectomy in the late 1990s though the modern paradigm of minimally invasive and endoscopic interventions. The authors present the retrospective and controlled data behind the "step-up approach" to PN treatment and discuss the application of current society guidance. Evidence based management of PN is characterized by early supportive care, and treatment by minimally invasive intervention when a patient is critically ill or persistently symptomatic. Appropriate choices when intervention is required include percutaneous drainage, minimally invasive surgery, and/or endoscopic treatment. The transition from open maximal necrosectomy to minimally invasive intervention has resulted in improved outcomes for patients, including gains in mortality, significant morbidity, and cost. The ideal precision management strategy for an individual patient remains an area of increasing understanding.

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胰腺坏死:范围综述。
急性胰腺炎(AP)是一种常见的消化道疾病,仅在美国,每年就有 275,000 人次入院治疗。胰腺坏死(PN)是急性胰腺炎最常见的并发症,胰腺坏死的发生与严重的发病率和死亡率增加有关。这篇专家综述评估了从上世纪 90 年代末最大限度的开放性胰腺坏死切除术时代到现代微创和内镜干预模式期间对无症状胰腺坏死的循证管理。作者介绍了 PN 治疗 "阶梯式方法 "背后的回顾性和对照数据,并讨论了当前社会指南的应用。循证治疗 PN 的特点是早期支持性护理,以及在患者病情危重或症状持续存在时进行微创介入治疗。需要干预时的适当选择包括经皮引流、微创手术和/或内窥镜治疗。从开放性最大坏死切除术到微创介入治疗的转变为患者带来了更好的治疗效果,包括降低死亡率、显著降低发病率和费用。针对个体患者的理想精准治疗策略仍是一个有待进一步了解的领域。
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