Clinical outcomes of combined necrotizing pancreatitis versus extrapancreatic necrosis alone

Wang, Mingjun; Wei, Ailin; Guo, Qiang; Zhang, Zhaoda; Lu, Honglin; Li, Ang; Hu, Weiming

doi:10.1016/j.pan.2015.10.010

Cited by 33 publications

(29 citation statements)

References 37 publications

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“…Necrotizing pancreatitis, as per the revised Atlanta classification, encompasses an entire spectrum of patients with combined pancreatic parenchymal and peri‐pancreatic necrosis as also patients with either of these two phenomena alone. Many recent reports, however, seem to suggest that the entity of peri‐pancreatic necrosis alone (extra‐pancreatic necrosis [EPN] alone) has prognosis that is better than pancreatic parenchymal necrosis but worse than interstitial pancreatitis . This has led to suggestions that EPN alone be considered as a distinctive third group while classifying acute pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

“…In a recent study of 334 patients of acute necrotizing pancreatitis of whom 49 (14.67%) had EPN alone, Wang et al . also reported the relatively good outcome associated with EPN alone vis‐à‐vis combined necrosis . However, this study included only those patients who had an intervention and excluded patients who improved with conservative management .…”

Section: Introductionmentioning

confidence: 99%

“…We reported EPN alone to be present in 22.5% of the patients with AP seen at a large tertiary care center in North India, but the study possibly had a referral bias as lesser number of patients had interstitial pancreatitis (10%) . A recent report from China reported EPN alone to constitute 6.3% of their patients of AP, but there was a selection bias as study included only those patients of necrotizing pancreatitis who underwent intervention …”

Section: Introductionmentioning

confidence: 99%

“…Many recent reports, however, seem to suggest that the entity of peri-pancreatic necrosis alone (extra-pancreatic necrosis [EPN] alone) has prognosis that is better than pancreatic parenchymal necrosis but worse than interstitial pancreatitis. [2][3][4][5] This has led to suggestions that EPN alone be considered as a distinctive third group while classifying acute pancreatitis. The present review summarizes the available literature about this entity and presents the current evidence comparing the outcome of patients with EPN alone with that of patients with interstitial and necrotizing pancreatitis (pancreatic with or without extra-pancreatic tissue/fat necrosis).…”

Section: Introductionmentioning

confidence: 99%

“…4 A recent report from China reported EPN alone to constitute 6.3% of their patients of AP, but there was a selection bias as study included only those patients of necrotizing pancreatitis who underwent intervention. 5 Prognosis of extra-pancreatic necrosis alone (Table 1). Sakorafas reported detailed clinical and imaging findings as well as outcomes in patients with EPN alone.…”

Section: Introductionmentioning

confidence: 99%

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Extra‐pancreatic necrosis alone: Contours of an emerging entity

Sharma

Bhasin

2016

J of Gastro and Hepatol

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Acute pancreatitis is of two morphologic types: interstitial edematous pancreatitis that is not associated with any tissue necrosis and necrotizing pancreatitis wherein the pancreatic parenchyma with or without varying amount of extra-pancreatic tissue/fat undergoes necrosis. Necrotizing pancreatitis has a worse outcome compared with interstitial pancreatitis because of increased severity related to a heightened systemic response and cytokine storm associated with tissue necrosis. Increasingly, an entity of extra-pancreatic necrosis (EPN) alone, wherein the pancreatic parenchyma is normal on an enhanced computed tomographic scan but the peri-pancreatic tissues undergo necrosis, is being recognized. Available data suggest that the outcomes in patients with EPN alone are between the excellent prognosis of patients with interstitial and adverse prognosis of patients with necrotizing pancreatitis. The extent of EPN also seems to determine the outcome. This review summarizes the currently available literature on this entity and various radiological scores that have been suggested to determine the presence and stage of EPN.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Extra‐pancreatic necrosis alone: Contours of an emerging entity

Sharma

Bhasin

2016

J of Gastro and Hepatol

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Role of CT Scan in Acute Pancreatitis

Afghani

Faghih²,

Singh

2021

Clinical Pancreatology for Practising Gastroenterologists and Surgeons

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Impact of the site of necrosis on outcome of acute pancreatitis

et al. 2018

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ObjecivesTo compare the clinical outcome of patients with extrapancreatic necrosis (EXPN) alone with that of acute interstitial pancreatitis (AIP), pancreatic parenchymal necrosis (PPN) alone, and combined PPN and EXPN.BackgroundThere are only a few studies in the literature in which EXPN has been recently recognized as a subtype of acute necrotizing pancreatitis (ANP), with a better prognosis.MethodsWe analyzed clinical data and outcome variables of 411 consecutive acute pancreatitis (AP) patients between January 2012 and December 2014. Contrast‐enhanced computed tomography (CECT) images of each patient were reviewed and characterized as AIP or ANP. Patients with ANP were divided into EXPN alone, PPN alone, and combined PPN and EXPN. Outcome variables were then compared between these groups.ResultsOf the 411 patients, 74 (18%) had AIP, and 337 (82%) had ANP. Patients with EXPN alone (n = 40; 11.8%) had similar outcomes as patients with PPN alone (n = 12; 3.5%); however, their outcome was worse than that of patients with AIP, with a higher frequency of persistent organ failure (POF), need for percutaneous catheter drainage (PCD), and longer length of hospitalization (LOH). Patients with combined PPN and EXPN (n = 285; 84.7%) had the worst clinical course, with higher frequency of POF, infected necrosis, intervention requirement, and longer LOH.ConclusionPatients with combined PPN and EXPN have a severe disease course with the worst clinical outcomes; patients with AIP patients have the most benign course, while patients with EXPN alone stand between the two extremes of disease course with an intermediate grade of severity.

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Clinical outcomes of combined necrotizing pancreatitis versus extrapancreatic necrosis alone

Cited by 33 publications

References 37 publications

Extra‐pancreatic necrosis alone: Contours of an emerging entity

Extra‐pancreatic necrosis alone: Contours of an emerging entity

Role of CT Scan in Acute Pancreatitis

Impact of the site of necrosis on outcome of acute pancreatitis

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