Sterile Fluid Collections in Acute Pancreatitis: Catheter Drainage Versus Simple Aspiration

Abstract

There is no apparent clinical benefit for catheter drainage of sterile fluid collections arising in acute pancreatitis as the length of hospital stay and mortality were similar between patients undergoing aspiration versus catheter drainage. However, almost half of patients treated with simple aspiration will require surgical or percutaneous drainage at some point. Disadvantages of chronic catheter drainage include a greater than 50% rate of bacterial colonization and the need for multiple sinograms and tube changes over an average duration of about 2 months.

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

“…Those who are against drainage treatment claim that it is the treatment itself which causes the dreadful complication, the infection of the fluid. According to the literature the rate of iatrogenous infection is about 8-27% [12,25,28,40]. Walser, Zerem et al report a very high, 50% rate of infection which is, in our opinion, the result of the irrigation 2-3 times a day [40,44].…”

“…According to the literature the rate of iatrogenous infection is about 8-27% [12,25,28,40]. Walser, Zerem et al report a very high, 50% rate of infection which is, in our opinion, the result of the irrigation 2-3 times a day [40,44]. To determine the correct rate of iatregenous infections treated without drainage or puncture a prospective randomized trial should be performed which is not available at this time.…”

“…The aim of this article is to analyse the indications, limits and results of the listed complications treated by percutaneous drainage (PD) which aggravate acute pancreatitis on the basis of the literature. superinfection of the fluid that can be confirmed by fine needle aspiration (FNA) [1, 2,11,19,25,33,37,40,44]. The APFC can be visualized by CT scan or ultrasound examination as well.…”

“…There are some who are satisfied with the clearing of the fluid collection with only one or repeated punctures in sterile cases. However, this is succesful only in a few cases and drainage or surgical intervention follows [6,28,40,44]. According to those who are pro drainage in the treatment of sterile acute peripancreatic fluid collections, drainage can be applied effectively [1, 3,4,14,21,25,34,35,40,44].…”

“…The authors do not recommend surgical treatment in the early phase of the illness because of the high morbidity and mortality rates. With the development of interventional radiology and manipulative laparo-endoscopy there are other possibilities to evacuate these fluid collections without operation [1, 6,11,14,21,25,35,40,44]. For the treatment of sterile fluid collection percutaneous puncture and drainage are widely applied.…”