Outcome following Necrotizing Pancreatitis

Abstract

Objective: To study the long term outcome following recovery from acute necrotizing pancreatitis in terms of structural and functional status of pancreas (both exocrine and endocrine) and to study the correlation, if any, of the long-term consequences with respect to the severity of necrotizing pancreatitis and between the groups of patients managed conservatively and operatively. Methods: All patients with a diagnosis of acute necrotizing pancreatitis based on Balthazar CT severity index (CTSI) in AIIMS, New Delhi following recovery of the illness were included in the study between the period from March, 2011 to June, 2012. Patients managed both operatively and nonoperatively were followed up at six months and at one year. Structural changes were assessed by ultrasound at 6 months and 1 year. CECT scan/ MRI with MRCP/ ERCP/ EUS were done if ultrasound reveals any abnormality. Exocrine function of pancreas was assessed by fecal fat and stool elastase and endocrine function by fasting blood sugar, fasting serum c-peptide and HbA1c levels. Results: Pancreatic atrophy was more in the operated patients compared to nonoperated patients at discharge and at 6 months of follow up. Pancreatic exocrine and endocrine insufficiency, were similar in both groups. Conclusion: There was a high correlation between extent of necrosis and subsequent development of pancreatic atrophy and diabetes in both groups of patients. Exocrine and endocrine functions deteriorate after necrotizing pancreatitis irrespective of conservative or operative treatment and there is no statistically significant difference between the two modes of treatment.