Review Article

Management of Acute Pancreatitis: Conservative Treatment and Step-Up Invasive Approaches—Evidence-Based Guidance for Clinicians

Table 4

Advantages and disadvantages of each minimally invasive technique.

Percutaneous approachEndoscopic approachVARDLaparoscopic approach
Multiple attemptsMultiple attemptsOne attemptOne attempt

Complication rate: 20% and mortality rate: 28%Complication rate: 28% and mortality rate: 5.6%Complication rate: 17.5% and mortality rate: 2.5%Conversion to open and mortality rate: 10%
Complications: intra-abdominal haemorrhage, colonic perforation, intestinal fistula, and pancreatic fistulaComplications: bleeding, perforation of abdominal cavity, and peritonitisComplications: colonic fistula, gastric and duodenal perforation, enteric fistula, pancreatic fistula, and retroperitoneal haemorrhageComplications: pancreatic fistula, recollection, and bleeding
Anesthesia: general or sedationAnesthesia: general or sedationAnesthesia: generalAnesthesia: general
Suitable for collections in the left pancreasSuitable for collections in the retrogastric space in contact with the posterior wall of the stomachSuitable for collections in the body and tail of the pancreasSuitable for all collections
Suitable for solid collectionsSuitable for predominant fluid collectionsSuitable for solid collectionsSuitable for predominant fluid collections
Possible in unstable patientsThe patient’s condition must be stablePossible in unstable patientsThe patient’s condition must be stable
Single used method: 44% and need for surgical treatment: 56%Single used method: 60% and need for surgical treatment: 20%–28%Single used method: 81% and need for surgical treatment: 19%Single used method: 80% and need for surgical treatment: 20%
References: [6672].