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<p>Necrotizing pancreatitis is the complicated course of an acute pancreatitis. Necrosis develops in about 5–20% of patients suffering from acute pancreatitis. A&#xa0;distinction is made between initial fluid accumulation and walled off necrosis after about 28&#xa0;days. The significantly increased mortality of up to 30% of necrotizing pancreatitis is due to the (secondary) infection of necrotic tissue, which occurs in about 1/3 of patients with necrotizing pancreatitis. In the case of infected necrosis, invasive therapy is indicated. For about 15&#xa0;years, there has been a&#xa0;recommendation for minimally invasive therapy and a&#xa0;move away from open surgical procedures. Minimally invasive strategies are divided into the “surgical step-up approach” and the “endoscopic step-up approach”. The central difference between the two approaches is the external transcutaneous access to necrosis in the surgical step-up. This results in an increased fistula rate as a&#xa0;decisive complication, thus, leading to the recommendation for the internal access route and thus endoscopic drainage therapy.</p>

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Akute nekrotisierende Pankreatitis

  • 期刊论文

  • 发表日期：

    2025年6月16日

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  • Alexander Arlt,
  • Christian Meinhardt,
  • Maximilian Bockhorn,
  • Jan Egberts,
  • Ulrich Rosien

摘要

Necrotizing pancreatitis is the complicated course of an acute pancreatitis. Necrosis develops in about 5–20% of patients suffering from acute pancreatitis. A distinction is made between initial fluid accumulation and walled off necrosis after about 28 days. The significantly increased mortality of up to 30% of necrotizing pancreatitis is due to the (secondary) infection of necrotic tissue, which occurs in about 1/3 of patients with necrotizing pancreatitis. In the case of infected necrosis, invasive therapy is indicated. For about 15 years, there has been a recommendation for minimally invasive therapy and a move away from open surgical procedures. Minimally invasive strategies are divided into the “surgical step-up approach” and the “endoscopic step-up approach”. The central difference between the two approaches is the external transcutaneous access to necrosis in the surgical step-up. This results in an increased fistula rate as a decisive complication, thus, leading to the recommendation for the internal access route and thus endoscopic drainage therapy.