Endoscopic treatment of infected necrosis

Acute pancreatitis is complicated by necrosis of the pancreas or peripancreatic tissue in around 20% of patients (6, 30). Necrotizing pancreatitis can often be treated successfully with a conservative approach, without the need for invasive intervention (21, 33, 34). In a subset of patients, however, there is a need for a more aggressive regimen which includes invasive intervention. The primary indication for this is bacterial infection of peripancreatic collections with walled-off necrosis, which occurs in around 30% of patients with necrotizing pancreatitis (21, 33, 34). Indications for invasive intervention in sterile necrosis include mechanical obstruction of the biliary or gastrointestinal tract, persisting abdominal discomfort and failure to thrive caused by persisting necrotic collections beyond 8 weeks after onset of the acute attack (21, 34).