Fluid collections can develop early after acute pancreatitis and many regress without intervention. The presence of a collection is not the same as an indication for treatment.
Walled-off necrosis contains both fluid and necrotic material. Intervention is driven by infection, persistent pain, gastric or intestinal obstruction, biliary compression or inability to maintain nutrition. Unnecessary early intervention can increase risk.
When treatment is required, a step-up strategy is often used. EUS-guided internal drainage may be followed by endoscopic necrosectomy if substantial solid necrosis remains. The number of sessions and type of stent are individual decisions.
Fever, chills, rapidly worsening pain, sepsis or inability to maintain nutrition require prompt reassessment and may need multidisciplinary management.
Walled-off necrosis contains both fluid and necrotic material. Intervention is driven by infection, persistent pain, gastric or intestinal obstruction, biliary compression or inability to maintain nutrition. Unnecessary early intervention can increase risk.
When treatment is required, a step-up strategy is often used. EUS-guided internal drainage may be followed by endoscopic necrosectomy if substantial solid necrosis remains. The number of sessions and type of stent are individual decisions.
Fever, chills, rapidly worsening pain, sepsis or inability to maintain nutrition require prompt reassessment and may need multidisciplinary management.
