Infected Necrotizing Pancreatitis: Evolving Interventional Strategies From Minimally Invasive Surgery to Endoscopic Therapy—Evidence Mounts, But One Size Does Not Fit All

Garg, Pramod Kumar; Zyromski, Nicholas J.; Freeman, Martin L.

doi:10.1053/j.gastro.2019.02.015

Cited by 27 publications

(21 citation statements)

References 25 publications

(57 reference statements)

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“…Each patient with WOPN should be treated individually and followed by a multidisciplinary team involving general surgeons, gastroenterologist, and radiologist [10]. Symptomatic or infected WOPN is commonly managed with antibiotics and percutaneous or endoscopic drainage, minimally invasive necrosectomy, or open surgery in advanced cases [11]. Complications may develop any time during the disease process until complete resolution of necrotic collection [12].…”

Section: Discussionmentioning

confidence: 99%

Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Mitrović¹,

Dugalić

Kovač

et al. 2020

Medicina

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Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.

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Section: Discussionmentioning

confidence: 99%

Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Mitrović¹,

Dugalić

Kovač

et al. 2020

Medicina

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“…The potential benefits early intervention could offer include: 1) relieving necrosis‐related systemic complications, which are at least partly caused by pro‐inflammatory cytokines, chemokines, free radicals, etc. released by local necrotic collection 9,26 ; 2) resolution of pressure symptoms like severe intra‐abdominal hypertension, which is an important predictor for unfavorable outcomes 27,28 ; and 3) timely drainage of early pancreatic infection, which was reported to be more common in patients with early POF, 29,30 that is, our study population.…”

Section: Discussionmentioning

confidence: 98%

Early on‐demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: A pilot randomized controlled trial

Dong

Chen

et al. 2021

J Hepato Biliary Pancreat

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Background/Purpose The current standard care for acute pancreatitis with acute necrotic collections (ANC) is to postpone invasive intervention for 4 weeks when indicated. However, in patients with persistent organ failure (POF), this delayed approach may prolong organ failure. In this study, we aimed to assess the feasibility and safety of earlier drainage for acute pancreatitis patients with ANC and POF. Methods A single‐center, randomized controlled trial was conducted. Eligible patients were randomly assigned to either the early on‐demand (EOD) group or the standard management (SM) group. Within 21 days of randomization, early drainage was triggered by unremitted or worsening organ failure in the EOD group. The primary endpoint was a composite of major complications/death during 90‐days follow‐up. Results Thirty patients were randomized. Within 21 days of randomization, eight of the 15 patients (53%) in the EOD group underwent percutaneous drainage compared to four of the 15 patients (27%) in the SM group (P = 0.26). The primary outcome occurred in three of the 15 (20%) patients in the EOD group and seven of the 15(46.7%) in the controls (P = 0.25, relative risk 0.43, 95%CI 0.14 to 1.35). Conclusions Although the EOD approach did not result in significant differences between groups, the primary outcome assessed in this trial demonstrated the potential for clinical benefits favoring early drainage.

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“…Multicentric studies showed that endoscopic necrosectomy has been associated with a reduced mortality rate compared with surgical necrosectomy 5 6. Nonetheless, endoscopic intervention has some limitations in regards to the location of the WOPN, since those that are further away from the gastric area and located near paracolic and pelvic gutters are not feasible for endoscopic treatment 7 8…”

Section: Discussionmentioning

confidence: 99%

“…Patients with WOPN must be treated in specialised centres with experience in pancreatic surgery and endotherapy 8…”

Section: Discussionmentioning

confidence: 99%

Walled-off pancreatic necrosis: a staged multidisciplinary step-up approach

et al. 2020

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Walled-off pancreatic necrosis (WOPN) is a rare complication of pancreatitis. We present the case of a woman in her eighties admitted for diffuse abdominal pain. She had a palpable abdominal mass and the CT scan showed necrosis throughout the tail of the pancreas, a peripancreatic and retrogastric hydroaerial collection (19 cm of diameter) and a calculus in the main biliary duct, thus establishing a diagnosis of emphysematous necrotising obstructive pancreatitis. A step-up approach was decided, first with removal of the biliary calculus, followed by a waiting period of 4 weeks in which the patient was under intravenous antibiotics. At re-evaluation, the CT scan showed a smaller and more organised collection, bounded by a wall, defining WOPN. At this stage, transgastric drainage via echoendoscopy was attempted, without success, followed by percutaneous CT-guided drainage, also with little effect. Surgical necrosectomy was then executed, as a final step, with a successful outcome.

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Infected Necrotizing Pancreatitis: Evolving Interventional Strategies From Minimally Invasive Surgery to Endoscopic Therapy—Evidence Mounts, But One Size Does Not Fit All

Cited by 27 publications

References 25 publications

Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Early on‐demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: A pilot randomized controlled trial

Walled-off pancreatic necrosis: a staged multidisciplinary step-up approach

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