Overview
Walled-off pancreatic necrosis (WON) is a complication of severe acute pancreatitis characterized by localized necrosis encapsulated by fibrous tissue, often requiring endoscopic or surgical intervention for management 1.Diagnosis
Clinical Presentation: Abdominal pain, fever, and signs of infection or obstruction 1.
Imaging: Contrast-enhanced CT or MRI is essential for diagnosis, showing encapsulated necrotic collections 1.
Endoscopic Ultrasound (EUS): Used to assess the anatomy and guide drainage procedures 1.Management
First-line Treatment: Endoscopic ultrasound-guided drainage using stents.
- Biflanged Metal Stents (BFMS): Shown to have higher reintervention-free clinical success compared to plastic stents 1.
Adjunctive Treatments: Antibiotics if infected WON, pain management, and nutritional support 1.Special Populations
No specific data provided on management differences for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 1.Key Recommendations
Use Biflanged Metal Stents for EUS-guided drainage of WON to achieve better reintervention-free clinical success at 4 weeks (Evidence: Strong 1).
Monitor and manage complications such as infection and obstruction with appropriate interventions (Evidence: Moderate 1).
Consider nutritional support and pain management as part of comprehensive care for patients with WON (Evidence: Expert opinion 1).References
1 Koduri KK, Jagtap N, Lakhtakia S, Jahangeer B, Asif S, Talukdar R et al.. Biflanged metal stents versus plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis: a randomized controlled trial. Endoscopy 2024. link