Xiao NJ, Cui TT, Liu F, Li W. Invasive intervention timing for infected necrotizing pancreatitis: Late invasive intervention is not late for collection. World J Clin Cases 2022; 10(23): 8057-8062 [PMID: 36159514 DOI: 10.12998/wjcc.v10.i23.8057]
Corresponding Author of This Article
Wen Li, AGAF, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. liwen@301hospital.com.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2022; 10(23): 8057-8062 Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8057
Invasive intervention timing for infected necrotizing pancreatitis: Late invasive intervention is not late for collection
Nian-Jun Xiao, Ting-Ting Cui, Fang Liu, Wen Li
Nian-Jun Xiao, Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
Ting-Ting Cui, Fang Liu, Department of Gastroenterology and Hepatology, Medical School of Chinese PLA, Beijing 100853, China
Wen Li, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Xiao NJ and Li W contributed to the review design; Xiao NJ wrote the manuscript; Xiao NJ and Cui TT edited the manuscript; Cui TT contributed to the audio core tip; Liu F and Li W contributed to the manuscript revising.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen Li, AGAF, PhD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. liwen@301hospital.com.cn
Received: March 2, 2022 Peer-review started: March 2, 2022 First decision: April 19, 2022 Revised: May 3, 2022 Accepted: June 24, 2022 Article in press: June 24, 2022 Published online: August 16, 2022
Abstract
With the advance of invasive interventions, the treatment model for infected necrotizing pancreatitis (INP) has shifted from open surgery to the step-up minimally invasive treatment. Late intervention, originating from the open surgery era, has been questioned in the minimally invasive period. With the emergence of new high-quality evidence about the timing for intervention, it seems to be increasingly apparent that, even in the age of minimal invasiveness, “late intervention” waiting for the necrotic collections to be encapsulated is still necessary. This opinion review mainly discusses the intervention timing for INP.
Core Tip: Infected necrotizing pancreatitis is a potentially lethal disease that should be identified and managed early. For patients who can be stabilized with antibiotics and supportive care, the invasive treatment, either endoscopic or percutaneous approach, should be delayed for at least four weeks. While patients whose infection cannot be controlled by medication alone may need percutaneous drainage first in 48-72 h, followed by minimally invasive surgery (if necessary). Endoscopic gastric fenestration may be performed in selected patients. This innovative alternative intervention should also be postponed to more than four weeks, waiting for the necrosis to mature and the capsular lesions to fuse with the gastric wall.
