Medical treatments of necrotizing pancreatitis

Lee, Sung Koo

Abstract

Pancreatic necrosis is associated with complications and mortality if the necrotic tissue becomes infected. The development of necrosis is associated with hypovolemia, vascular spasm and hemoconcentration. Control of hypovolemia, use of antibiotics, nutritional support and endoscopic treatments are the nonsurgical options in the mamagement of necrotizing pancreatitis. The proper use of antibiotics in acute pancreatitis remains controversial, however, current evidence favors the use of prophylactic antibiotics in necrotizing pancreatitis. Enteral feeding is usually well tolerated, however, total parenteral nutrition may be necessary. Several studies have demonstrated that enteral feeding via a nasojejunal tube infused distal to the ligament of Treitz is associated with a decreased rate of complications, including infection, when compared to total parenteral nutrition. Infected pancreatic necrosis can be managed by percutaneous or endoscopic dranage. The choice of drainage routes depends on the disease status, availability of the interventional radiologist or gastroenterologist. For improvement of outcomes and reducing complications in the management of necrotizing pancreatitis, proper patient selection and technical expertise are required.