Topic Highlight
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World J Gastroenterol. Dec 7, 2014; 20(45): 16925-16934
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16925
Is necrosectomy obsolete for infected necrotizing pancreatitis? Is a paradigm shift needed?
Yu-Chung Chang
Yu-Chung Chang, Department of Surgery, Chung Shan Medical University Hospital, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Author contributions: Chang YC researched and wrote the manuscript for the Highlight Topic: “Necrotizing Pancreatitis.”
Correspondence to: Yu-Chung Chang, MD, PhD, Department of Surgery, Chung Shan Medical University Hospital, College of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Road, South Dist., Taichung 40201, Taiwan. changmdphd@yahoo.com
Telephone: +886-4-24739595 Fax: +886-4-24756437
Received: February 28, 2014
Revised: September 20, 2014
Accepted: September 29, 2014
Published online: December 7, 2014
Core Tip

Core tip: A shift from early, prompt surgical necrosectomy to delay until liquefaction has become the global consensus for treatment of infected necrotizing pancreatitis, which allows drainage procedures and minimally invasive techniques to play a more important role before definitive surgery. Success rates of 80% and single-digit mortality rates are reported with transluminal endoscopic drainage and irrigation with a percutaneous gastrostomy access route. Zero mortality using transluminal endoscopic drainage without a necrosectomy can be achieved. A paradigm shift from necrosectomy to drainage for the treatment of walled-off necrotizing pancreatitis should be considered.