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      개정된 대한췌장담도학회 급성췌장염 임상진료지침: 국소 합병증 및 괴사성 췌장염의 치료 = Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Treatment of Local Complication and Necrotizing Pancreatitis

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      https://www.riss.kr/link?id=A108014801

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      다국어 초록 (Multilingual Abstract) kakao i 다국어 번역

      In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis.
      Korean J Pancreas Biliary Tract 2022;27(1):32-39
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      In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, intervent...

      In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis.
      Korean J Pancreas Biliary Tract 2022;27(1):32-39

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      참고문헌 (Reference)

      1 Catalano MF, "Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis" 42 : 214-218, 1995

      2 Besselink MG, "Timing of surgical intervention in necrotizing pancreatitis" 142 : 1194-1201, 2007

      3 van Baal MC, "The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis" 155 : 442-448, 2014

      4 Lang EK, "The efficacy of palliative and definitive percutaneous versus surgical drainage of pancreatic abscesses and pseudocysts : a prospective study of 85 patients" 84 : 55-64, 1991

      5 Teoh AY, "Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage" 8 : 310-318, 2016

      6 Rau B, "Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis" 85 : 179-184, 1998

      7 Hartwig W, "Reduction in mortality with delayed surgical therapy of severe pancreatitis" 6 : 481-487, 2002

      8 Garg PK, "Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis" 8 : 1089-1094, 2010

      9 Melman L, "Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts" 23 : 267-271, 2009

      10 Delattre JF, "Percutaneous ultrasound-guided drainage in the surgical treatment of acute severe pancreatitis" 129 : 497-502, 2004

      1 Catalano MF, "Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis" 42 : 214-218, 1995

      2 Besselink MG, "Timing of surgical intervention in necrotizing pancreatitis" 142 : 1194-1201, 2007

      3 van Baal MC, "The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis" 155 : 442-448, 2014

      4 Lang EK, "The efficacy of palliative and definitive percutaneous versus surgical drainage of pancreatic abscesses and pseudocysts : a prospective study of 85 patients" 84 : 55-64, 1991

      5 Teoh AY, "Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage" 8 : 310-318, 2016

      6 Rau B, "Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis" 85 : 179-184, 1998

      7 Hartwig W, "Reduction in mortality with delayed surgical therapy of severe pancreatitis" 6 : 481-487, 2002

      8 Garg PK, "Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis" 8 : 1089-1094, 2010

      9 Melman L, "Primary and overall success rates for clinical outcomes after laparoscopic, endoscopic, and open pancreatic cystgastrostomy for pancreatic pseudocysts" 23 : 267-271, 2009

      10 Delattre JF, "Percutaneous ultrasound-guided drainage in the surgical treatment of acute severe pancreatitis" 129 : 497-502, 2004

      11 Heider R, "Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients" 229 : 781-789, 1999

      12 Adams DB, "Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst" 215 : 571-578, 1992

      13 Bang JY, "Outcomes after implementing a tailored endoscopic step-up approach to walled-off necrosis in acute pancreatitis" 101 : 1729-1738, 2014

      14 Bang JY, "Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial" 68 : 1200-1209, 2019

      15 Palanivelu C, "Management of pancreatic pseudocyst in the era of laparoscopic surgery--experience from a tertiary centre" 21 : 2262-2267, 2007

      16 Bhasin DK, "Management of multiple and large pancreatic pseudocysts by endoscopic transpapillary nasopancreatic drainage alone" 101 : 1780-1786, 2006

      17 Lenhart DK, "MDCT of acute mild(nonnecrotizing)pancreatitis : abdominal complications and fate of fluid collections" 190 : 643-649, 2008

      18 Khaled YS, "Laparoscopic versus open cystgastrostomy for pancreatic pseudocysts : a case-matched comparative study" 21 : 818-823, 2014

      19 Worhunsky DJ, "Laparoscopic transgastric necrosectomy for the management of pancreatic necrosis" 219 : 735-743, 2014

      20 Kirkpatrick AW, "Intra-abdominal hypertension and the abdominal compartment syndrome : updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome" 39 : 1190-1206, 2013

      21 Nemoto Y, "Interventions for walled off necrosis using an algorithm based endoscopic step-up approach : outcomes in a large cohort of patients" 17 : 663-668, 2017

      22 Nguyen BL, "Influence of the etiology of pancreatitis on the natural history of pancreatic pseudocysts" 162 : 527-531, 1991

      23 Working Group IAP/APA Acute Pancreatitis Guidelines, "IAP/APA evidence-based guidelines for the management of acute pancreatitis" 13 (13): e1-e15, 2013

      24 Aranha GV, "Evaluation of therapeutic options for pancreatic pseudocysts" 117 : 717-721, 1982

      25 Varadarajulu S, "Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial" 145 : 583-590, 2013

      26 Gornals JB, "Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent" 27 : 1428-1434, 2013

      27 Giovannini M, "Endoscopic ultrasonography-guided pancreatic drainage" 22 : 221-, 2012

      28 van Brunschot S, "Endoscopic or surgical step-up approach for infected necrotising pancreatitis : a multicentre randomised trial" 391 : 51-58, 2018

      29 Arvanitakis M, "Endoscopic management of acute necrotizing pancreatitis : European Society of Gastrointestinal Endoscopy(ESGE)evidence-based multidisciplinary guidelines" 50 : 524-546, 2018

      30 Kato S, "Efficacy, safety, and long-term follow-up results of EUS-guided transmural drainage for pancreatic pseudocyst" 2013 : 924291-, 2013

      31 Bang JY, "Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections : a systematic review" 27 : 486-498, 2015

      32 Mouli VP, "Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis : a systematic review and meta-analysis" 144 : 333-340, 2013

      33 Panwar R, "Efficacy and safety of metallic stents in comparison to plastic stents for endoscopic drainage of peripancreatic fluid collections : a meta-analysis and trial sequential analysis" 10 : 403-414, 2017

      34 Mier J, "Early versus late necrosectomy in severe necrotizing pancreatitis" 173 : 71-75, 1997

      35 Hungness ES, "Early debridement for necrotizing pancreatitis : is it worthwhile?" 194 : 740-745, 2002

      36 Varadarajulu S, "EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts" 68 : 649-655, 2008

      37 Ross AS, "Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis : long-term clinical outcomes" 79 : 929-935, 2014

      38 Rodriguez JR, "Debridement and closed packing for sterile or infected necrotizing pancreatitis : insights into indications and outcomes in 167 patients" 247 : 294-299, 2008

      39 van der Waaij LA, "Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions : a pooled analysis" 62 : 383-389, 2005

      40 Cheruvu CV, "Conservative treatment as an option in the management of pancreatic pseudocyst" 85 : 313-316, 2003

      41 Teoh AYB, "Consensus guidelines on the optimal management in interventional EUS procedures : results from the Asian EUS group RAND/UCLA expert panel" 67 : 1209-1228, 2018

      42 Italian Association for the Study of the Pancreas(AISP), "Consensus guidelines on severe acute pancreatitis" 47 : 532-543, 2015

      43 Pupelis G, "Clinical significance of increased intraabdominal pressure in severe acute pancreatitis" 102 : 71-74, 2002

      44 Banks PA, "Classification of acute pancreatitis--2012 : revision of the Atlanta classification and definitions by international consensus" 62 : 102-111, 2013

      45 Sekimoto M, "Changes in management of acute pancreatitis before and after the publication of evidence-based practice guidelines in 2003" 17 : 17-23, 2010

      46 Banks PA, "CT-guided aspiration of suspected pancreatic infection : bacteriology and clinical outcome" 18 : 265-270, 1995

      47 Bang JY, "An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis" 156 : 1027-1040, 2019

      48 Baron TH, "American Gastroenterological Association clinical practice update : management of pancreatic necrosis" 158 : 67-75, 2020

      49 van Santvoort HC, "A step-up approach or open necrosectomy for necrotizing pancreatitis" 362 : 1491-1502, 2010

      50 Binmoeller KF, "A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections" 43 : 337-342, 2011

      51 Morton JM, "A national comparison of surgical versus percutaneous drainage of pancreatic pseudocysts : 1997-2001" 9 : 15-21, 2005

      52 van Santvoort HC, "A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome" 141 : 1254-1263, 2011

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