Interventions for Necrotizing Pancreatitis: A Multidisciplinary Approach

Interventions for necrotizing pancreatitis have recently undergone a shift away from open surgery and towards minimally invasive techniques, obviating the need for open necrosectomy in most cases. Recommendations of a recent international multidisciplinary consensus conference and evidence-based guidelines have emphasized the superiority of minimally invasive approaches over standard surgical approaches. Percutaneous catheter or endoscopic transluminal drainage, followed by endoscopic or video-assisted retroperitoneal debridement as needed, is associated with improved outcomes over traditional open necrosectomy for patients with infected necrosis. Endoscopic transluminal drainage and necrosectomy are emerging as the primary approach in many centers, with adjunctive use of percutaneous catheter drainage and minimally invasive retroperitoneal necrosectomy techniques as needed. Enteral nutritional support is an essential component of management. The success of all of these techniques depends on concerted efforts of a team of interventional endoscopists, radiologists, intensivists, and surgeons dedicated to the management of severe acute pancreatitis and its complications. This review provides an overview of minimally invasive techniques for management of necrotizing pancreatitis, including indications, timing, advantages, and disadvantages.