Step-up approach for severe acute necrotizing pancreatitis

Authors

  • Ureña-Argudo Jonathan Fabricio
  • Cabezas Barragán Lincoln Alexander
  • Ramirez-Pulua Denis Alexander
  • Méndez Orellana Blas Luciano
  • Apolo-Aguilar Valeria Lizbeth
  • Ordóñez-Caicedo Olga Maria
  • Nieves-Condoy Jefferson Fabian

DOI:

https://doi.org/10.34119/bjhrv8n4-217

Keywords:

video-assisted retroperitoneal debridement, acute pancreatitis, step-up approach

Abstract

Severe acute pancreatitis accounts for 20% of cases, and pancreatic necrosis and infection significantly increase morbidity and mortality. The estimated mortality for infected necrosis without organ failure is around 1.4%, for necrosis without infection with organ failure it is 19.8% and for infected necrosis with organ failure it is 35.2%. The currently accepted management approach is the step-up approach; however, there is disagreement regarding the best approach and protocol options. The Step-Up approach offers good results, but it must be adapted to each case and center to make its results reproducible. Our aim is to discuss the importance of adapting the protocol to the individual needs of each case.

References

Sagar AJ, Khan M, Tapuria N. Evidence-Based Approach to the Surgical Management of Acute Pancreatitis. The Surgery Journal. 2022 Oct 22;08(04):e322–35.

Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach. Gastroenterology. 2019 May;156(7):1994-2007.e3.

van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis. New England Journal of Medicine. 2010 Apr 22;362(16):1491–502.

Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic Transgastric vs Surgical Necrosectomy for Infected Necrotizing Pancreatitis. JAMA. 2012 Mar 14;307(10):1053.

Tang P, Zha Q, Zhou L, Yang Q, He M, Zhu S, et al. Effectiveness of digestive endoscopy and surgery in the treatment of necrotizing pancreatitis: a meta-analysis and systematic review. Gland Surg. 2021 Sep;10(9):2754–65.

Jearth V, Rana SS. Endoscopic step up: When and how. Surg Open Sci. 2022 Oct;10:135–44.

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Published

08/19/2025

How to Cite

FABRICIO, U.-A. J.; ALEXANDER, C. B. L.; ALEXANDER, R.-P. D.; LUCIANO, M. O. B.; LIZBETH, A.-A. V.; MARIA, O.-C. O.; FABIAN, N.-C. J. Step-up approach for severe acute necrotizing pancreatitis. Brazilian Journal of Health Review, [S. l.], v. 8, n. 4, p. e81590, 2025. DOI: 10.34119/bjhrv8n4-217. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/81590. Acesso em: 19 oct. 2026.

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Section

Original Papers