Hollenbach Marcus, Feisthammel Jürgen, Hoffmeister Albrecht
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.
Internist (Berl). 2021 Oct;62(10):1055-1064. doi: 10.1007/s00108-021-01154-2. Epub 2021 Sep 21.
Acute 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.
Classification of AP by the revised Atlanta classification and the occurrence of local or systemic complications. Summary of current evidence with respect to endoscopic management.
Inspection of the current literature from specialist journals and current guidelines.
The 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.
Interventional endoscopy has become established as the standard for treatment of severe AP.
急性胰腺炎（AP）是一种常见的胃肠道疾病。约80%的患者病情呈轻度，保守治疗即可；然而，20%的患者会发展为重症急性胰腺炎，并伴有局部和全身并发症。本文重点介绍目前推荐的重症急性胰腺炎的内镜治疗方法。
根据修订后的亚特兰大分类法对急性胰腺炎进行分类，并阐述局部或全身并发症的发生情况。总结目前关于内镜治疗的证据。
查阅专业期刊的现有文献及当前指南。
根据全身（低血压、肾衰竭、肺衰竭）和/或局部并发症，如急性胰周液体积聚（APFC）、胰周假性囊肿（PPC）、急性坏死性液体积聚（ANC）和包裹性坏死（WON），将急性胰腺炎分为轻度、中度或重度。近年来，已确立了对感染性ANC、WON和PPC进行分期内镜治疗的方法。第一步是内镜超声引导下穿刺引流，并置入塑料或全覆膜金属支架。对于实性成分或引流不充分的情况，建议行经胃内镜坏死组织清除术。重症急性胰腺炎的治疗需要在专业中心进行多学科管理，并定期重新评估治疗效果。
介入性内镜检查已成为重症急性胰腺炎治疗的标准方法。
