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Semin intervent Radiol
DOI: 10.1055/s-0044-1801358
Review Article

Percutaneous Interventions and Necrosectomy in the Management of Peripancreatic Collections

Mohammad Mirza-Aghazadeh-Attari   *
1   Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
,
Seyed Sina Zakavi   *
2   Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Kamyar Ghabili
3   Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Melike N. Harfouche
4   Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
,
Reena Jha
5   Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Juan C. Camacho
6   Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, Florida
,
Jamil Shaikh
7   Department of Vascular and Interventional Radiology, University of South Florida, Tampa, Florida
,
Pejman Radkani
8   Department of Surgery, The Georgetown University School of Medicine, Washington, District of Columbia
,
Walid M. Chalhoub
9   Department of Gastroenterology, The Georgetown University School of Medicine, Washington, District of Columbia
,
Merve Ozen
10   Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Phoenix, Arizona
,
Peiman Habibollahi
11   Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
,
John B. Smirniotopoulos
12   Division of Vascular and Interventional Radiology, Department of Radiology, MedStar Washington Hospital Center, Washington, District of Columbia
13   Georgetown University Medical School, Washington, District of Columbia
,
Nariman Nezami
13   Georgetown University Medical School, Washington, District of Columbia
14   Division of Vascular and Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
15   Lombardi Comprehensive Cancer Center, Washington, District of Columbia
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Abstract

Acute pancreatitis (AP) is a severe inflammatory condition of the pancreas with significant morbidity and mortality, particularly in its necrotizing form. This review explores the management of peripancreatic collections and in particular necrotizing pancreatitis, focusing on the evolution from traditional open surgical methods to contemporary minimally invasive image-guided techniques. AP can lead to various local complications, including pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Imaging plays a crucial role in diagnosing complications of AP, while treatment approaches have shifted toward a step-up strategy involving percutaneous, endoscopic, and minimally invasive methods. Percutaneous necrosectomy, combining mechanical and chemical debridement, has shown promising results. Mechanical necrosectomy uses devices like baskets and retrieval nets, while chemical necrosectomy adds agents like hydrogen peroxide and streptokinase. Current evidence suggests that the step-up approach, starting with percutaneous drainage or necrosectomy and escalating to endoscopic or surgical interventions, if necessary, improves patient outcomes. The review underscores the need for a multidisciplinary approach in managing complicated AP and highlights ongoing advancements in minimally invasive techniques.

Keywords

pancreatitis - acute necrotizing pancreatitis - walled-off necrosis - debridement - interventional radiology

* These authors contributed equally to the study.




Publication History

Article published online:
06 January 2025

© 2025. Thieme. All rights reserved.

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