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How to treat pancreatic necrosis

On this episode of Small Talk, Big Topics our hosts Drs. Matt Whitson and CS Tse speak to the authors of the AGA Clinical Practice Update on the Management of Pancreatic Necrosis.
Small Talks, Big GI Topics
Small Talks, Big GI Topics

In this episode of the Small Talk, Big Topics podcast, hosts Matthew Whitson and CS Tse are joined by Drs. Todd Barron and Andrew Wang. Dr. Todd Barron is the director of advanced therapeutic endoscopy, division of gastroenterology and hepatology at the University of North Carolina. Dr. Wang is a board-certified gastroenterologist who serves as chief of the section of interventional endoscopy in the division of gastroenterology and hepatology and as the director of interventional endoscopy at the University of Virginia. Together, they authored the AGA Clinical Practice Update: Management of Pancreatic Necrosis.

Their conversation begins as Dr. Wang explains that a Clinical Practice Update, or CPU, is an official AGA publication meant to provide clinical guidance on an area of high medical importance. They give an update by experts in the field. Pancreatic necrosis has been associated with a high mortality rate for years, which led Drs. Baron and Wang to study better treatment methods. Dr. Baron was one of the first doctors to take care of pancreatic necrosis endoscopically. The evolution of his treatment plan went from plastic stents and irrigation, to direct necrosectomy, to now placing large bore stents and reserving direct necrosectomy to patients who do not respond to that large bore stent approach. With this new protocol, the need for surgery has gone down.

Another important point of their CPU is when to intervene on a patient’s necrosis. You want to choose an intervention that encourages healing but does not introduce adverse events. Dr. Baron advises treating the patient not the CT scan. There aren’t a lot of hard and fast rules, he explains, so you have to look at the whole picture and follow the clinical guidelines to help you make the best decision for our patient. The procedures laid out in their CPU should be done by those with at least a year of advanced endoscopic training.

As the episode ends, Matthew asks the guests to give advice to med students, and to share the best advice they’d received. Dr. Baron shares the best advice he received was to stay involved in patient care and make sure you’re treating them right. Dr. Wang agrees and adds that knowing your weaknesses is part of taking good care of the patient.

This CPU was co-authored by Christopher J. DiMaio and Katherine A. Morgan.

Learn more about Dr. Andrew Wang.
Learn more about Dr. Todd Baron.
Check out their Clinical Practice Update.
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