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Treatment and Clinical Management of Necrotizing Pancreatitis
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Treatment and Clinical Management of Necrotizing Pancreatitis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 732

Special Issue Editor

Dr. Apostolos Gaitanidis

E-Mail Website
Guest Editor
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
Interests: necrotizing pancreatitis; infected necrosis; step-up approach; necrosectomy; minimally invasive surgery; artificial intelligence; lumen-apposing metal stent; pancreatic necrosis

Special Issue Information

Dear Colleagues,

Necrotizing pancreatitis remains one of the most complex and lethal entities of intra-abdominal disease, with major gaps in evidence and wide variability in global practice. It has evolved from a condition managed primarily with early open surgery to one treated with delayed, minimally invasive, multidisciplinary strategies. Despite these advances, it remains associated with high morbidity, prolonged hospitalizations, significant mortality, and persistent gaps in standardized care. This Special Issue aims to synthesize current knowledge, identify unresolved challenges, and promote innovations that improve outcomes in necrotizing pancreatitis. Scope includes diagnostics, intervention timing, minimally invasive techniques, management of complications, ICU management, and long-term sequelae. Emerging areas include optimized endoscopic step-up algorithms, refinement of lumen-apposing metal stent protocols, advanced techniques for management of bleeding complications, and targeted therapies for inflammatory modulation. We welcome original research and review articles addressing key areas of interest in necrotizing pancreatitis.

Dr. Apostolos Gaitanidis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • necrotizing pancreatitis
  • infected necrosis
  • step-up approach
  • necrosectomy
  • minimally invasive surgery
  • artificial intelligence
  • lumen-apposing metal stent
  • pancreatic necrosis

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Published Papers (2 papers)

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Research

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18 pages, 13896 KB  
Article
Interdisciplinary Step-Up Strategy for Infected Pancreatic Walled-Off Necrosis: Sinus Tract Endoscopic Necrosectomy (STEN) Versus Laparoscopic-Assisted Necrosectomy (LAPN)
by Valerie Kremo, Julia Mühlhäusser, Hanna Plazer, Isabella Fleischmann, Andreas Scheiwiller, Stephan Baumeler, Simon Bütikofer, Martin Bolli, Francesco Mongelli and Jörn-Markus Gass
J. Clin. Med. 2026, 15(10), 3694; https://doi.org/10.3390/jcm15103694 - 11 May 2026
Viewed by 230
Abstract
Background/Objectives: Acute infected necrotizing pancreatitis remains associated with substantial morbidity and mortality. The step-up approach combines minimal-invasive drainage with endoscopic transgastric or percutaneous necrosectomy and has been shown to improve outcomes compared with open surgery. Laparoscopic-assisted necrosectomy (LAPN) may be performed in [...] Read more.
Background/Objectives: Acute infected necrotizing pancreatitis remains associated with substantial morbidity and mortality. The step-up approach combines minimal-invasive drainage with endoscopic transgastric or percutaneous necrosectomy and has been shown to improve outcomes compared with open surgery. Laparoscopic-assisted necrosectomy (LAPN) may be performed in cases of infected walled-off necrosis (WON) following percutaneous drainage and is typically carried out using laparoscopic instrumentation. A newly implemented interdisciplinary approach includes sinus tract endoscopy, guided necrosectomy (STEN), which employs flexible endoscopy through a surgically created sinus tract and offers a less invasive and more targeted alternative to LAPN, providing improved visualization of complex necrotic cavities and facilitating repeatable step-up debridement. This study aimed to assess the introduction of STEN compared with LAPN in the management of infected WON within a step-up approach. Methods: A retrospective analysis of patients with infected walled-off necrosis (WON) treated using a step-up approach between 2019 and 2025 was conducted. Patients who underwent CT-guided percutaneous drainage followed by either STEN or LAPN were included. Demographic characteristics and clinical outcomes were collected. The primary endpoint was a composite outcome comprising major complications and 6-month mortality. Secondary outcomes included overall complication rates, need for reinterventions, and length of hospital stay. Results: During the study period, 17 patients were included. All patients were managed using a step-up approach: nine underwent STEN and eight underwent LAPN. In the STEN group, six patients (66.7%) met the primary endpoint, all due to major complications, with no mortality observed. In the LAPN group, the primary endpoint occurred in four patients (50.0%), including one death and three major complications. Conclusions: Our study showed that both STEN and LAPN were effective in treating infected WON within a step-up approach. STEN and LAPN showed comparable outcomes. However, these findings should be interpreted as exploratory and with caution given the retrospective design and the small sample size of this study. Further studies with larger patient cohorts are warranted to confirm these findings and to better define the role of this technique in the management of infected necrotizing pancreatitis. Full article
(This article belongs to the Special Issue Treatment and Clinical Management of Necrotizing Pancreatitis)
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Review

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15 pages, 613 KB  
Review
Preventing Post-ERCP Pancreatitis: A Pragmatic Clinical Pathway from Periprocedural Prophylaxis to Early Postprocedural Triage
by Se Woo Park, Amine Achemlal, Kyong Joo Lee, Dong Hee Koh and Jin Lee
J. Clin. Med. 2026, 15(10), 3917; https://doi.org/10.3390/jcm15103917 - 19 May 2026
Viewed by 183
Abstract
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically relevant adverse event after ERCP. Although several preventive measures are supported by current evidence, their application in routine practice is often fragmented across the pre-procedural, intra-procedural, and post-procedural phases of care. As [...] Read more.
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) remains the most frequent and clinically relevant adverse event after ERCP. Although several preventive measures are supported by current evidence, their application in routine practice is often fragmented across the pre-procedural, intra-procedural, and post-procedural phases of care. As a result, patients with evolving risk may not receive timely escalation of prophylaxis or appropriately tailored post-procedural monitoring. This review provides a pragmatic clinical framework for integrating evidence-based PEP prevention with early post-ERCP risk stratification. We summarize baseline risk assessment before ERCP, distinguish routinely applicable preventive measures from strategies reserved for selected high-risk situations, and emphasize the importance of intra-procedural reassessment when procedural events such as difficult cannulation or unintended pancreatic duct manipulation increase risk in real time. We further discuss the role of early symptom assessment and post-procedural amylase/lipase measurement in supporting triage decisions, including selective observation, admission, or same-day discharge in appropriately selected patients. This integrated approach may improve consistency in routine ERCP care while highlighting important limitations related to generalizability, local resources, and implementation. Full article
(This article belongs to the Special Issue Treatment and Clinical Management of Necrotizing Pancreatitis)
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