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JOURNAL ARTICLE

Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach

Guru Trikudanathan, Daan Wolbrink, Hjalmar van Santvoort, Shawn Mallery, Martin Freeman, Marc Besselink
Gastroenterology 2019 February 15
30776347
The incidence of acute pancreatitis continues to rise, inducing substantial medical and social burden, with annual costs exceeding two billion dollars in the USA alone. Although the majority of patients develop mild pancreatitis, 20% develop severe and/or necrotizing pancreatitis, requiring advanced medical and interventional care. Morbidity resulting from local and systemic complications as well as invasive interventions result in mortality rates historically as high as 30%. There has been substantial evolution of strategies for interventions in recent years, from open surgery to minimally invasive surgical and endoscopic step-up approaches. In contrast to the advances in invasive procedures for complications, early management still lacks curative options and consists of adequate fluid resuscitation, analgesics and monitoring. Many challenges remain, including comprehensive management of the entire spectrum of the disease, which requires close involvement of multiple disciplines at specialized centers.

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