Endoscopic necrosectomy for infected pancreatic necrosis

This review details the indications, technique, and outcomes of endoscopic necrosectomy for the treatment of pancreatic necrosis. Data from 14 previous reports revealed that the rate of complete resolution of pancreatic necrosis with endoscopic necrosectomy ranged from 53% to 100%. The procedure-related morbidity was 0–46% and the overall mortality was 0–13%. In particular, two recent multicenter studies with large cohort numbers reported that successful resolution was achieved in 80–91% of cases, morbidity was 14–26% and mortality was 5.8–7.5%. Interestingly, delayed intervention is currently preferred to early intervention, since maturation of the necrotic bed develops encapsulation and demarcation of peripancreatic collections, namely walled-off pancreatic necrosis. Such structural changes facilitate necrosectomy and improve conditions for intervention, thereby decreasing the risk of complications such as bleeding and perforation. It is now believed that intervention should be delayed to approximately 3–4 weeks after the onset of pancreatitis if the patient's condition is kept stable by conservative treatment.