Endoscopy 2018; 50(05): 524-546
DOI: 10.1055/a-0588-5365
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines

Marianna Arvanitakis
Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium
,
Jean-Marc Dumonceau
Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Jörg Albert
Robert-Bosch-Krankenhaus, Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Stuttgart, Germany
,
Abdenor Badaoui
Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
,
Maria Antonietta Bali
Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium
,
Marc Barthet
Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France
,
Marc Besselink
Department of Surgery, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
,
Jacques Deviere
Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium
,
Alexandre Oliveira Ferreira
Gastroenterology Unit, Department of Surgery, Hospital Beatriz Ângelo, Loures, Portugal
,
Tibor Gyökeres
Dept. of Gastroenterology, Medical Centre Hungarian Defense Forces, Budapest, Hungary
,
Istvan Hritz
Semmelweis University, 1st Department of Surgery, Endoscopy Unit, Budapest, Hungary
,
Tomas Hucl
Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
,
Marianna Milashka
Service de Gastroentérologie et Hépatologie, Hôpital Desgenettes, Lyon, France
,
Ioannis S. Papanikolaou
Hepatogastroenterology Unit, Second Department of Internal Medicine, Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
,
Jan-Werner Poley
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Stefan Seewald
Gastroenterologie, Klinik Hirslanden, Zurich, Switzerland
,
Geoffroy Vanbiervliet
Centre Hospitalier Universitaire de Nice, Pole D.A.R.E, Endoscopie Digestive, Nice, France
,
Krijn van Lienden
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Hjalmar van Santvoort
Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands and Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, The Netherlands
,
Rogier Voermans
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Myriam Delhaye
Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium
,
Jeanin van Hooft
Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
09 April 2018 (eFirst)

MAIN RECOMMENDATION

1 ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible.

Weak recommendation, low quality evidence.

2 ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections.

Strong recommendation, moderate quality evidence.

FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear.

Weak recommendation, low quality evidence.

3 ESGE recommends initial goal-directed intravenous fluid therapy with Ringer’s lactate (e. g. 5 – 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals.

Strong recommendation, moderate quality evidence.

4 ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis.

Strong recommendation, high quality evidence.

5 ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis.

Strong recommendation, low quality evidence.

ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient.

Weak recommendation, low quality evidence.

6 ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise.

Strong recommendation, moderate quality evidence.

7 ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise.

Weak recommendation, low quality evidence.

8 ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome.

Strong recommendation, low quality evidence.

Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.

Strong recommendation, low quality evidence.

Tables e1 – e16