Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Jagielski, Mateusz; Smoczyński, Marian; Studniarek, Michał; Adrych, Krystian

doi:10.5114/aoms.2018.75606

Cited by 11 publications

(12 citation statements)

References 29 publications

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“…The current guidelines on managing ANP recommend postponing endoscopic treatment of necrotic collection by at least 4 weeks since the disease onset 1 , 6 – 9 , 11 , 15 . In early phase of ANP, it is recommended to intensify conservative treatment with intravenous antibiotics, if necessary 16 , 17 , which can delay or even prevent surgical intervention 6 . However, some patients will still require interventional treatment for ANCs within first 4 weeks of ANP 11 – 15 , 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Almost half of all ANCs regresses spontaneously, while the other half tends to evolve into WOPN 4 , 5 . In half of the patients with WOPN, the fluid collection undergoes spontaneous resorption without a need for intervention 4 – 6 . The other half of the patients develops symptoms related to fluid collection, which is an indication for interventional treatment 4 – 6 .…”

Section: Introductionmentioning

confidence: 99%

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Early endoscopic treatment of symptomatic pancreatic necrotic collections

Jagielski

Piątkowski

Jackowski

2022

Sci Rep

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EUS-guided transmural endoscopic drainage is commonly used in the treatment of WOPN in the late phase of ANP. The role of endoscopic intervention remains unclear in the early phase of ANP. This study aimed to prospectively evaluate early endoscopic treatment of ANCs compared with endoscopic drainage of WOPN. Overall, 71 patients with ANP who underwent transmural endoscopic drainage for necrotic collections were included. Endoscopic intervention was performed within the first four weeks of ANP in 25 (35.21%) patients with ANC (Group 1) and in 46 (64.79%) patients after four weeks since the onset of ANP with WOPN (Group 2). The overall mean age of patients was 49.9 (22–79) years and 59 of them were males. The mean time of active drainage and duration of total endoscopic treatment was 26.8 and 16.9 days (P = 0.0001) and 270.8 and 164.2 days (P = 0.0001) in Groups 1 and 2, respectively. The average total number of endoscopic interventions was 9.5 and 4.5 in Groups 1 and 2, respectively (P = 0.0001). The clinical success rate, frequency of complications of endoscopic interventions, long-term success rate, and recurrence rate were not significantly different between the groups (P > 0.05 for each). Transmural endoscopic drainage is effective method of treatment of early ANCs within the first four weeks of ANP. However, compared with endoscopic intervention in WOPN, more interventions and longer duration of drainage are required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early endoscopic treatment of symptomatic pancreatic necrotic collections

Jagielski

Piątkowski

Jackowski

2022

Sci Rep

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“…Studies on follow-up of asymptomatic patients with WON showed that >50% have either decreased in size or resolution of collection without any intervention [ 9 , 21 ]. In our study, 14 (46.6%) patients had regression of WON size, from 76.57±21 mm to 51.07±21.62 mm during the three-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis

Kumar¹,

Sonika²,

Sachdeva³

et al. 2023

Cureus

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Background and objectivesStudies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methodsIn this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. ResultsOf the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most common etiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) and CTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. ConclusionAround one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.

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“…They are compression symptoms such as obstructive jaundice or ileus [10][11][39][40]. Patients with pancreatic fluid collections without clinical symptoms should not be treated interventionally [10][11]41], because as we have presented in our study, these collections are susceptible to spontaneous regression during the hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…In the last decades we can observe an intensive development of minimally invasive treatment methods of consequences of AP [22][23][24][26][27][38][39][40][41][42][43][44][45]. The application of interventional methods of treatment was presented in our previous publications [38][39][40][41][42]. In the presented sample interventional treatment was needed in 46/202 (22.77%) patients with pancreatic and peripancreatic fluid collections, because of persistent symptoms related with fluid collection.…”

Section: Discussionmentioning

confidence: 99%

Clinical and epidemiological aspects of acute pancreatitis - 10 years of single-center experience

Jagielski¹,

Kijowski²,

Fruczek³

et al. 2019

Eur J Trans Clin Med

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Background: We can observe an increase in acute pancreatitis (AP) incidence in the recent years. Materials and methods: Retrospective clinical data analysis of 370 patients with AP, hospitalized between 2007 and 2016 at our Department. Results: AP was diagnosed during 406 hospitalisation in 370 patients [average age 52.15 (21-93), 237(64.05%) male]. AP of high clinical severity was diagnosed in 60/370 (16.22%) patients. Average time of hospitalisation was 16.13 (1-121) days. Mortality was 12/406 (2.96%). The after effect of AP in form of parapancreatic fluid reservoirs was diagnosed in 202/406 (54.59%) cases. Comparing the early phase of the study (2007-2011) and the later one (2012-2016) a shorter time of hospitalisation was proven and a lower mortality of the patients in the later phase of the study. Analysis of patients' blood tests revealed that patients with severe AP have significantly elevated levels of inflammatory parameters and amylase comparing to group with mild and moderate AP, during the first days of hospitalisation. Conclusion: The development of conservative treatment options for AP, especially in early stages of the illness, has significantly shortened the duration of hospitalisation of patients with AP at our Department.

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Spontaneous regression of asymptomatic walled-off pancreatic necrosis

Cited by 11 publications

References 29 publications

Early endoscopic treatment of symptomatic pancreatic necrotic collections

Early endoscopic treatment of symptomatic pancreatic necrotic collections

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis

Clinical and epidemiological aspects of acute pancreatitis - 10 years of single-center experience

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