Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 193

Patients with acute pancreatitis complicated by WON may be asymptomatic or may have significant symptoms with critical illness. Historically, these patients underwent open necrosectomy when they were symptomatic and critically ill, especially in the setting of concern for infected necrosis; however, this was associated with significant morbidity and mortality and overall poor outcomes long term. Over the past two decades, the pendulum has shifted, and there is now significant data to support the use of step‐up approaches focusing on endoscopic and percutaneous drainage with avoidance of surgical debridement in the early stages and only using minimally invasive surgical options for treatment failures. As the ability to perform endoscopic access of these collections has improved, multiple tools have been added to the endoscopist’s armamentarium to access and debride these lesions, with substantial data favoring the use of minimally invasive approaches. Most recently, the advent of LAMS has again markedly altered management strategies by enabling ongoing access to these collections with wider tracts and decreased risk of migration. Though LAMS are physically more costly than plastic stents, these costs are often mitigated by a variety of other factors, often favoring the use of LAMS as the preferable access option endoscopically. Finally, no matter what the interventional strategy, patients with WON have substantially benefited from multidisciplinary team management.