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Asian consensus statements on endoscopic management of walled‐off necrosis. Part 2: Endoscopic management
Author(s) -
Isayama Hiroyuki,
Nakai Yousuke,
Rerknimitr Rungsun,
Khor Christopher,
Lau James,
Wang HsiuPo,
Seo Dong Wan,
Ratanachuek Thawee,
Lakhtakia Sundeep,
Ang Tiing Leong,
Ryozawa Shomei,
Hayashi Tsuyoshi,
Kawakami Hiroshi,
Yamamoto Natusyo,
Iwashita Takuji,
Itokawa Fumihide,
Kuwatani Masaki,
Kitano Masayuki,
Hanada Keiji,
Kogure Hirofumi,
Hamada Tsuyoshi,
Ponnudurai Ryan,
Moon Jong Ho,
Itoi Takao,
Yasuda Ichiro,
Irisawa Atsushi,
Maetani Iruru
Publication year - 2016
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13398
Subject(s) - medicine , expert opinion , delphi method , pancreatic abscess , intensive care medicine , pancreatitis , surgery , computer science , artificial intelligence
Walled‐off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high‐quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.