**9. Conclusions**

Pancreatic necrosis is a significant and challenging disease process with mortality reaching beyond 30% in most studies. Intervention begins with supportive care and nutritional support. However, invasive therapy is often needed, especially when necrosis becomes infected.

First-line interventions for pancreatic necrosis may be percutaneous or transmural endoscopic drainage depending on if the necrosis is encapsulated, the accessibility of the necrosis, the patient's clinical condition, and the capabilities of the hospital. These minimally-invasive interventions are often successful as monotherapy, without the need for further intervention. They are also preferable to open or laparoscopic necrosectomy when performed as part of a step-up approach.

Despite all of the improvement in minimally-invasive management of pancreatic necrosis, some percentage of patients continue to require surgical intervention. Both laparoscopic and open approaches have been shown to be effective via transgastric, transgastrocolic, and transmesocolic routes.

When pancreatic necrosis is further complicated by a disconnected pancreatic duct, although minimally-invasive management has been described and shown to be effective, surgical management remains standard of care.

Despite the advances in care driven by clinical trials and new technology, management of pancreatic necrosis remains difficult. Further study is needed to reduce the morbidity and mortality of this devastating disease.
