Necrotizing pancreatitis — ESEGH MCQ

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HardManagement of Acute PancreatitisNecrotizing pancreatitisESEGH

A patient with infected walled-off pancreatic necrosis needs intervention. The collection abuts the stomach and is anatomically accessible. What is the preferred first source-control approach?

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Correct answer: A — Endoscopic transluminal drainage using a step-up strategy

The best answer is “Endoscopic transluminal drainage using a step-up strategy”. The minimally invasive step-up pathway begins with endoscopic drainage, reserving necrosectomy or surgery for inadequate response. “Immediate open necrosectomy in every patient” is less appropriate because open surgery carries greater morbidity and is not first-line when endoscopic access is feasible “Prophylactic antibiotics alone without drainage despite ongoing sepsis” is less appropriate because established infected necrosis may need source control “Total pancreatectomy” is less appropriate because this is disproportionate and causes profound endocrine and exocrine failure “Percutaneous drainage despite straightforward endoscopic access” is less appropriate because NICE prefers the endoscopic route when anatomically possible

Reference: NICE NG104 pancreatitis: https://www.nice.org.uk/guidance/ng104/chapter/Recommendations