Percutaneous Endoscopic Necrosectomy (PEN): Is the PEN Mightier Than the VARD?

Excerpt

Necrotizing pancreatitis, one of the most feared and morbid complications of acute pancreatitis (AP), is seen in 5–10% of AP patients [1]. Very often, necrotic collections get infected which warrants drainage and debridement. Infected necrosis, typically a late event in the natural course of AP, can occur early in a quarter of the patients [2]. Typically, this is managed conservatively with intravenous antibiotics as current guidelines recommend delaying invasive intervention for at least 4 weeks after initial presentation to allow the collection to become “walled off” [3]. Occasionally necrotizing pancreatitis with clear evidence of infection despite maximal medical support may warrant an earlier intervention for drainage and/or debridement [2]. …