Affiliations 

  • 1 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • 2 Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 3 Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
  • 4 Department of Surgery, Endoscopic Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  • 5 Endoscopic Division, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
  • 6 Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
  • 7 Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
  • 8 Asian Institute of Gastroenterology, Hyderabad, India
  • 9 Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
  • 10 Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
  • 11 Department of Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan
  • 12 Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
  • 13 First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
  • 14 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
  • 15 Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
  • 16 Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan
  • 17 Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan
  • 18 Prince Court Medical Center, Kuala Lumpur, Malaysia
  • 19 Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon/Seoul, Korea
  • 20 Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
  • 21 Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
  • 22 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
PMID: 27044023 DOI: 10.1111/jgh.13394

Abstract

Walled-off necrosis (WON) is a relatively 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, 25 experts from 8 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 1 of this statement focused on the epidemiology, diagnosis and timing of intervention.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.