2022 Volume 37 Issue 5 Pages 251-256
According to a nationwide epidemiological survey of acute pancreatitis in 2016, the fatality rate for patients with severe acute pancreatitis 2 weeks after onset showed no improvement compared to 2011, suggesting that there is room for improvement in the treatment of local complications such as walled-off necrosis, which is problematic in the late onset phase. Against this background, the description of interventional therapy for local pancreatic complications was substantially revised in the 2021 guidelines. As key points for revision, it was suggested that when performing interventional treatment of patients with infected pancreatic necrosis, an endoscopic step-up approach is used 4 weeks after onset, a surgical step-up approach is chosen when the endoscopic approach is difficult, and retroperitoneal necrosectomy is performed when a surgical necrosectomy is performed. In the treatment of disconnected pancreatic duct syndrome, surgical treatment such as pancreatectomy, pancreatico-jejunostomy, and cyst-jejunostomy are performed when endoscopic treatment such as ultrasound endoscopic drainage is not effective.
