• Marcus Hollenbach, Jürgen Feisthammel, and Albrecht Hoffmeister.
• Bereich Gastroenterologie, Klinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland. marcus.hollenbach@medizin.uni-leipzig.de.
• Internist (Berl). 2021 Oct 1; 62 (10): 1055-1064.

BackgroundAcute pancreatitis (AP) represents a frequent gastrointestinal diseases. Approximately 80% of patients have a mild course of the disease and conservative treatment is sufficient; however, 20% of patients develop a severe AP with local and systemic complications. This article focuses on the currently recommended endoscopic management of severe AP.ObjectiveClassification of AP by the revised Atlanta classification and the occurrence of local or systemic complications. Summary of current evidence with respect to endoscopic management.Material And MethodsInspection of the current literature from specialist journals and current guidelines.ResultsThe AP is classified as mild, moderate or severe based on systemic (hypotension, renal failure, lung failure) and/or local complications, such as acute peripancreatic fluid collections (APFC), peripancreatic pseudocysts (PPC), acute necrotic collections (ANC) and walled-off necrosis (WON). In recent years the staged endoscopic treatment of infected ANC, WON and PPC has become established. The initial step is the endoscopic ultrasound-guided puncture and drainage with plastic or lumen-apposing metal stents. For solid components or insufficient drainage, a transgastric endoscopic necrosectomy is recommended. The treatment of severe AP requires an interdisciplinary management in specialized centers and regular re-evaluation of the therapeutic efficacy.ConclusionInterventional endoscopy has become established as the standard for treatment of severe AP.© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

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