Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen.

About 20% of patients with acute pancreatitis develop a necrotising form with a worse prognosis due to frequent appearance of organ failure(s) and/or infection of necrosis. Aims of the present study was to evaluate the "step up" approach treatment of infected necrosis in terms of: feasibility, success in resolving infection, morbidity of procedures, risk factors associated with death and long-term sequels.In this observational retrospective monocentric study in the real life, necrotizing acute pancreatitis at the stage of infected walled-off necrosis were treated as follow: first step with drainage (radiologic and/or endoscopic-ultrasound-guided with lumen apposing metal stent); in case of failure, minimally invasive necrosectomy sessions(s) by endoscopy through the stent and/or via retroperitoneal surgery (step 2); If necessary open surgery as a third step. Efficacy was assessed upon to a composite clinical-biological criterion: resolution of organ failure(s), decrease of at least two of clinico-biological criteria among fever, CRP serum level, and leucocytes count).Forty-one consecutive patients were treated. The step-up strategy: (i) was feasible in 100% of cases; (ii) allowed the infection to be resolved in 33 patients (80.5%); (iii) Morbidity was mild and rapidly resolutive; (iv) the mortality rate at 6 months was of 19.5% (significant factors: SIRS and one or more organ failure(s) at admission, fungal infection, size of the largest collection ≥ 16 cm). During the follow-up (median 72 months): 27% of patients developed an exocrine pancreatic insufficiency, 45% developed or worsened a previous diabetes, 24% had pancreatic fistula and one parietal hernia.Beside a very good feasibility, the step-up approach for treatment of infected necrotizing pancreatitis in the real life displays a clinico-biological efficacy in 80% of cases with acceptable morbidity, mortality and long-term sequels regarding the severity of the disease.© 2024. The Author(s).

The International Association of Pancreatology, alongside the American Pancreatic Association, the European Pancreatic Club, the Indian Pancreas Club, and the Japan Pancreas Society, decided to update its earlier guidelines for the management of acute pancreatitis (AP) given the remarkable advances in our understanding of AP and its management over the last decade.These organizations put together a group of international experts to address important issues related to the management of AP. Guideline Development Groups comprising international domain experts framed clinically relevant questions and conducted thorough literature searches and systematic reviews to address the questions. Questions were framed in the PICO (Participant, Intervention, Comparator, and Outcome) format where appropriate. The evidence from the literature was synthesized to develop evidence-based recommendations for each question. The quality of evidence and the strength of the recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). For some questions, we have provided Good Practice Statements if enough direct evidence was unavailable.The guidelines pertain to 18 domains comprising 96 questions. The recommendations cover almost all aspects of managing AP, including pain control, fluid therapy, patient stabilization, nutritional support, conservative and interventional treatment for infected necrotizing pancreatitis, management of complications, discharge criteria, guidance on follow-up, and strategies for prevention of recurrence. Specific types of AP, such as those associated with pregnancy, trauma, and metabolic factors have been given special attention.The recommendations presented here should serve as an evidence-based resource for practicing physicians and caregivers to treat patients with AP more effectively. In addition, the guidelines identify areas for future research, mainly targeted therapies for controlling systemic inflammation and mitigating organ dysfunction.Copyright © 2025 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10-20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up.A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described.A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5 cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up.According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.© 2024. The Author(s).

“step-up”升阶梯模式是当代感染坏死性胰腺炎（INP）的重要治疗模式之一，部分病人因此获益。然而，INP病情复杂多变决定了其治疗不可千篇一律采用同一种方法，而是需要根据病人具体情况，采用有针对性的治疗方案。对部分势必需要外科干预的病人应跨越传统的“step-up”序贯治疗程序，宜采取“step-jump”跨阶梯治疗策略对病人提前外科干预。应对病人的实际情况进行分型，构建INP不同干预方式的临床预测模型，从而进行更精准的分类治疗。高度一体化的多学科综合治疗协作组诊疗模式克服了专科治疗的局限，建立以疾病为中心的多学科一体化技术平台将是未来INP治疗的发展方向。