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Journal of Gastronenterology and Digestive Diseases
|
Volume 3
J u n e 2 5 - 2 6 , 2 0 1 8 | D u b l i n , I r e l a n d
GASTROENTEROLOGY
International Conference on
TREATMENT OF SEVERE ACUTE PANCREATITIS AND ITS
COMPLICATIONS
Enver Zerem
University of Tuzla, Bosnia and Herzegovina
T
he management of severe form of acute pancreatitis varies with the severity and depends on the type of complication that
requires treatment. Severe acute pancreatitis is associated with high morbidity and mortality due to the development of
pancreatic and extra-pancreatic necrosis, their subsequent infection and multisystem organ failure. Despite overall reduced
mortality in the last decade, SAP is a devastating disease that is associated with mortality ranging from less than 10% to as
high as 85%, according to various studies. The management of SAP is complicated because of the limited understanding of the
pathogenesis and multi-causality of the disease, uncertainties in outcome prediction and few effective treatment modalities.
Generally, sterile necrosis can be managed conservatively in the majority of cases with a low mortality rate (12%). However,
infection of pancreatic necrosis can be observed in 25%–70% of patients with necrotizing disease; it is generally accepted that
the infected non-vital tissue should be removed to control the sepsis. Laparotomy and immediate debridement of the infected
necrotic tissue have been the gold standard treatment for decades. However, several reports have shown that early surgical
intervention for pancreatic necrosis could result in a worse prognosis compared to cases where surgery is delayed or avoided.
Therefore, several groups worldwide have developed new, minimally invasive approaches for managing infected necrotizing
pancreatitis. The applicability of these techniques depends on the availability of specialized expertise and a multidisciplinary
team dedicated to the management of SAP and its complications. Although no universally accepted treatment algorithm exists,
the step-up approach using close monitoring, percutaneous or endoscopic drainage, followed by minimally invasive video-
assisted retroperitoneal debridement has demonstrated to produce superior outcomes to traditional open necrosectomy and
may be considered as the reference standard intervention for this disorder.
zerem@live.comJ Gastroenterol Dig Dis 2018, Volume 3