Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

Grinsven, Janneke van; Brunschot, Sandra van; Bakker, Olaf J.; Bollen, Thomas L.; Boermeester, Marja A.; Bruno, Marco J.; Dejong, Cornelis H. C.; Dijkgraaf, Marcel G. W.; Eijck, Casper H. van; Fockens, Paul; Goor, Harry van; Gooszen, Hein G.; Horvath, Karen D.; Lienden, Krijn P. van; Santvoort, Hjalmar C. van; Besselink, Marc G.

doi:10.1111/hpb.12491

Cited by 25 publications

(24 citation statements)

References 27 publications

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“…There is no consensus on the timing of PCD in the stepup approach. A significant variation in the timing of PCD could be observed among the reports by different centers [16], ranging from 9 to 55 days after the onset of symptoms [5]. Sugimoto et al have shown that PCD can achieve better outcomes if proactively performed in the early stages of necrotizing pancreatitis before the development of severe sepsis [17].…”

Section: Discussionmentioning

confidence: 99%

The effect of technical details of percutaneous catheter drainage on the clinical outcomes of infected necrotizing pancreatitis patients

Zhang

Ding

et al. 2019

Turk J Med Sci

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Background/aim: This study aimed to investigate the effect of technical details of percutaneous catheter drainage (PCD) on the clinical outcomes of patients with infected necrotizing pancreatitis (INP). Materials and methods:A total of 44 INP patients treated in our hospital from October 2013 to October 2015 were included. The correlations of the first PCD treatment data and the clinical outcomes were analyzed. Results:The number of catheters was positively correlated with hospital readmission (r = 0.335, P = 0.032). Receiver operating characteristic curve analysis showed that patients with ≥ 3 catheters were more likely to have hospital readmission. Patients with pleural effusion undergoing thoracentesis were more likely to have new intensive care unit admission (P = 0.025) and bleeding in need of intervention (P = 0.032). Patients with more effusion regions had higher incidences of mortality (P = 0.012) and new intensive care unit admissions (2.44 ± 1.03 vs. 1.88 ± 0.80; P = 0.059). Patients with PCD only were less likely to have new intensive care unit admissions (22.22% vs. 54.55%; P = 0.038) than those with PCD + small incision or/and videoscopic assisted retroperitoneal debridement. Conclusion:Number of catheters greater than three was associated with unfavorable outcomes of PCD treatment in INP patients. Patients that received PCD treatment only had better outcomes.

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Section: Discussionmentioning

confidence: 99%

The effect of technical details of percutaneous catheter drainage on the clinical outcomes of infected necrotizing pancreatitis patients

Zhang

Ding

et al. 2019

Turk J Med Sci

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“…The utilization of FNA aspiration and culture has become less favourable due to a 20-25% false negative rate, potentially as a result of the timing of the FNA as well as prior antibiotic usage (14). International experts agree that currently there is no consensus on the role of FNA and therefore it is not used routinely (44). For example, a stable patient with a positive FNA can potentially be treated with antibiotics alone and conversely patients with a high level of clinical suspicion and/or organ failure with a negative FNA will progress to further surgical intervention.…”

Section: Diagnosis Of Infectionmentioning

confidence: 99%

Managing Infected Pancreatic Necrosis

Thomson¹,

Dijk²,

Brand³

et al. 2018

chr

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The management of infected pancreatic necrosis has historically been based on early, open necrosectomy, associated with significant mortality. In recent years, an evidence based transformation has occurred towards the step-up approach consisting of percutaneous catheter drainage, if necessary, followed by minimally invasive necrosectomy. More recently the endoscopic step-up approach has gained popularity. This review evaluates the diagnosis, prevention and treatment of infected necrotizing pancreatitis. Key points in managing infected pancreatic necrosis: - multidisciplinary team approach in tertiary level centres; - no indication for prophylactic antibiotics or probiotics; - nasogastric, enteral nutrition indicated after 72 hours, if oral feeding is insufficient; - only intervene in infected necrosis; - delay intervention until "walled-off necrosis"; - step-up approach of percutaneous or endoscopic catheter drainage, followed by minimally invasive necrosectomy, if required; - endoscopic strategies are preferable where possible.

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“…Current literature shows that 35-64% of patients with INP can be treated with delayed catheter drainage, without the need for invasive necrosectomy [9,13]. In a recent international survey, although not evidence based, 45% of expert pancreatologists proclaimed that they immediately proceed with catheter drainage once infected pancreatic necrosis has been established [12]. Indeed, various case series suggest that encapsulation is not a ‘sine qua non' for catheter drainage to be successful [13].…”

Section: Treatment Of Infected Pancreatic Necrosismentioning

confidence: 99%

“…With the oral diet and on-demand tube feeding strategy, only approximately one third of patients required a nasojejunal feeding tube. It is difficult to speculate on factors that explain the observed differences with previous trials and observational studies, which suggested an improved outcome after early nasoenteric tube feeding as compared with total parenteral nutrition, other than study design and methodology [8,10,11,12,13] The timing of early nasoenteric tube feeding was similar to the timing mentioned in previous studies and similar criteria for enrolling patients at high risk for complications were used. One of the major issues with observational studies is that one cannot differentiate between cause and effect; for instance, less severely ill patients may have been fed earlier.…”

Section: Feeding In Pancreatitismentioning

confidence: 99%

Improving the Outcome of Acute Pancreatitis

Bruno

2016

Dig Dis

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Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

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Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

Abstract: Background: The optimal diagnostic strategy and timing of intervention in infected necrotizing

Cited by 25 publications

References 27 publications

The effect of technical details of percutaneous catheter drainage on the clinical outcomes of infected necrotizing pancreatitis patients

The effect of technical details of percutaneous catheter drainage on the clinical outcomes of infected necrotizing pancreatitis patients

Managing Infected Pancreatic Necrosis

Improving the Outcome of Acute Pancreatitis

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