Evidence-based management of necrotizing pancreatitis.

OPINION STATEMENT: Pancreatic necrosis may result as a complication of acute pancreatitis, often causing significant morbidity and mortality. There are many recommendations concerning the management of pancreatic necrosis, including non-operative management with supportive care and antibiotics, computed tomography (CT)-guided percutaneous drainage, endoscopic transluminal drainage, and operative necrosectomy. Historically, pancreatic necrosis has been treated surgically. However, surgical management of pancreatic necrosis is associated with high mortality (6-28 %) and morbidity (19-62 %). Thus, endoscopic therapy has emerged as a relatively new minimally invasive technique for treating infected and/or symptomatic pancreatic necrosis in the last decade. Although there have been two randomized trials comparing endoscopic transluminal drainage versus operative necrosectomy, there is little data regarding timing, indication, and outcomes of these procedures.