| [ Summary ] |
The revised Atlanta classification, released in 2012, defined the following 4 conditions as local complications of acute pancreatitis：acute peripancreatic fluid collection (APFC), acute necrotic collection (ANC), pancreatic pseudocyst (PPC), and walled‒off necrosis (WON). Based on the concepts of the revised Atlanta classification, the International Association of Pancreatology (IAP) /American Pancreatic Association (APA) guidelines and the Japanese clinical guidelines for acute pancreatitis were revised in 2013 and 2015, respectively. The indications for intervention in necrotizing pancreatitis were mostly limited to infectious walled‒off necrosis or infectious pancreatic pseudocysts. The optimal strategy for treating these lesions was to initially perform an image‒guided percutaneous or transluminal drainage, followed by, if necessary, an endoscopic or surgical necrosectomy (step‒up approach). These interventions should be delayed until the collection has become walled‒off for at least 4 weeks. These novel minimally invasive methods should be performed by skillful endoscopists or surgeons in high‒volume centers. |