Acute necrotizing pancreatitis: challenges and interventions—a narrative review

Acute pancreatitis (AP) is a complicated disease with rising incidence over the years. Twenty percent of AP will develop into acute necrotizing pancreatitis (ANP). Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches. Infected pancreatic necrosis (IPN) is the most serious event of ANP and associated with extremely poor prognosis. The contrast-enhanced computed tomography(CECT)-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype. Nevertheless, many challenges are still remaining during the treatment of ANP. Including the balance between endoscopic and surgical approaches, and the selection of optimal timing of surgical intervention for infected necrosis. In nowadays treatment scenario of ANP, the necessity for open surgery remains to be debated. Despite of the development of advanced interventional techniques, postoperative residual infection (PRI) remains thorny, and effective prevention and treatment of PRI is of significance.