Current Standards in the Treatment of Necrotizing Pancreatitis - What Is Evidence-Based?

Current Standards in the Treatment of Necrotizing Pancreatitis - What Is Evidence-Based? Mild edematous acute pancreatitis usually recovers with simple medical treatment, whereas necrotizing acute pancreatitis is characterized by high morbidity and mortality. Due to the lack of causal treatment options, therapy of necrotizing pancreatitis is limited to the treatment of symptoms and complications. Patients with acute pancreatitis caused by gallstones should undergo early endoscopic retrograde cholangiopancreatography. Enteral nutrition should be used in preference to parenteral nutrition, and selective decontamination of the bowel should be performed. The routine use of prophylactic antibiotics cannot be recommended yet in light of inconclusive evidence. Pancreatic debridement and drainage is indicated in patients with infected necrosis but time of surgical intervention should be delayed at least 2-3 weeks to allow demarcation of necrotic areas. The most common surgical approach is open necrosectomy followed by closed lavage of the debrided cavity. Interventional and minimally invasive procedures are mainly used in the treatment of pancreatitis-associated complications.