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Korean J Pancreas Biliary Tract > Volume 18(2):2013 > Article
The Korean Journal of Pancreas and Biliary Tract 2013;18(2):31-41.
급성 췌장염 진료 권고안: 급성 췌장염의 국소 합병증과 괴사성 췌장염의 치료
김태현1, 서동완2, 이승옥3, 김성훈3
원광대학교 의과대학 내과, 2울산대학교 의과대학 서울아산병원 내과"
Clinical Practice Guideline for Acute Pancreatitis: The Treatment of Local Complication of Acute Pancreatitis and Necrotizing Pancreatitis
Tae Hyeon Kim1, Dong Wan Seo3, Seung-Ok Lee, Seong Hun Kim
1Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
ABSTRACT
Acute pancreatitis is a common and potentially lethal disease. It is associated with significant morbidity and consumes enormous health care resources. Over the last two decades, the treatment of acute pancreatitis has undergone fundamental changes based on new conceptual insights and evidence from clinical studies. The majority of patients with necrotizing pancreatitis have sterile necrosis, which can be successfully treated conservatively. Patients with infected necrosis generally need to undergo an intervention which should ideally be delayed as long as possible, preferably 4 weeks or longer after the onset of disease, for better demarcation and liquefaction of the necrosis. Intervention has shifted from primary open necrosectomy in an early disease stage to a step-up approach, starting with catheter drainage, if needed followed by minimally invasive surgical or endoscopic necrosectomy. Interventional treatment such as percutaneous drainage or endoscopic drainage or surgery should be performed for pancreatic pseudocysts that give rise to symptoms and accompany complications. Applicability of these techniques depends on the availability of specialized expertise and a multidisciplinary team dedicated to the management of severe acute pancreatitis and its complications. This guideline review provides an overview of current standards for conservative and invasive treatment of necrotizing pancreatitis and its local complication such as pseudocyst and abscess.
Keywords: necrotizing pancreatitis, sterile pancreatic necrosis, infected pancreatic necrosis, pancreatic pseudocyst, pancreatic abscess
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