Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach

Gastroenterology. 2019 May;156(7):1994-2007.e3. doi: 10.1053/j.gastro.2019.01.269. Epub 2019 Feb 15.


The incidence of acute pancreatitis continues to rise, inducing substantial medical and social burden, with annual costs exceeding $2 billion in the United States alone. Although most patients develop mild pancreatitis, 20% develop severe and/or necrotizing pancreatitis, requiring advanced medical and interventional care. Morbidity resulting from local and systemic complications as well as invasive interventions result in mortality rates historically as high as 30%. There has been substantial evolution of strategies for interventions in recent years, from open surgery to minimally invasive surgical and endoscopic step-up approaches. In contrast to the advances in invasive procedures for complications, early management still lacks curative options and consists of adequate fluid resuscitation, analgesics, and monitoring. Many challenges remain, including comprehensive management of the entire spectrum of the disease, which requires close involvement of multiple disciplines at specialized centers.

Keywords: Acute Pancreatitis; Necrotizing Pancreatitis; Severe Acute Pancreatitis.

Publication types

  • Review

MeSH terms

  • Animals
  • Evidence-Based Medicine
  • Health Status
  • Humans
  • Incidence
  • Pancreatitis, Acute Necrotizing* / diagnosis
  • Pancreatitis, Acute Necrotizing* / mortality
  • Pancreatitis, Acute Necrotizing* / therapy
  • Predictive Value of Tests
  • Severity of Illness Index
  • Treatment Outcome