Abstract
Therapeutic intervention and surgery of acute pancreatitis in the 2010 guidelines have been dramatically revised into intervention for local complications in the 2015 guidelines, by incorporating the revised Atlanta classification and the confirmed evidence of step-up approach for necrotizing pancreatitis. The definition of local complications after acute pancreatitis and their approach have been extensively changed not only because the term "pancreatic abscess" had been discarded and instead a new concept of "walled-off necrosis" (WON) has been adopted, but also because the concept of step-up approach to local complications has been adopted in the 2015 Guidelines. Percutaneous drainage or endoscopic transluminal drainage should be first given regardless of the type of local complications when clinical symptoms and blood test findings deteriorate. If possible, therapeutic intervention should be performed after 4 weeks of onset, when the necrosis has been sufficiently walled off, that is, until the time of development of WON.
