Endoscopic Management of Necrotizing Pancreatitis: A Case Report and Review of the Literature.

Abstract

Severe acute pancreatitis has two predominant phases. The first, "early" phase (1-2 weeks) is characterized by a severe pro-inflammatory state and is best ameliorated with conservative management. The second, "late" phase is a more complex immune-compromised state, during which pancreatic fluid collections become demarcated and walled-off. During this phase, patients are at an increased risk of infection and necrosis secondary to break in the gut barrier. Therefore, treatment becomes more complicated. Though open surgical necrosectomy has historically been the treatment of choice for infected pancreatic necrosis, it carries a mortality rate up to 40 percent, likely due to additional physiologic stress in an already pro-inflammatory state. A growing body of evidence suggests that primary minimally invasive approaches, including endoscopy, can be used with equivalent or increased efficacy and lower morbidity and mortality rates than the traditional methods.