Korean J Pancreas Biliary Tract.  2022 Jan;27(1):32-39. 10.15279/kpba.2022.27.1.32.

Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Treatment of Local Complication and Necrotizing Pancreatitis

• Choi YH
• Kim TH
• Seo HI
• Han SY

• KMID: 2525397
• DOI: http://doi.org/10.15279/kpba.2022.27.1.32

Abstract

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.

Keyword

Acute peripancreatic fluid collection; Pancreatic pseudocyst; Acute necrotic collection; Walled-off necrosis; 급성췌장주위액체저류; 췌장가성낭종; 급성괴사저류; 구역성 췌장괴사