OBJECTIVE: In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking. METHODS: A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis. RESULTS: 315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p<0.001), persistent multiple organ failure (15% vs 36%, p<0.001), infected necrosis (16% vs 47%, p<0.001), intervention (18% vs 57%, p<0.001) and mortality (9% vs 20%, p<0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16). CONCLUSION: EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar.
OBJECTIVE: In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking. METHODS: A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis. RESULTS: 315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p<0.001), persistent multiple organ failure (15% vs 36%, p<0.001), infected necrosis (16% vs 47%, p<0.001), intervention (18% vs 57%, p<0.001) and mortality (9% vs 20%, p<0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16). CONCLUSION: EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar.
Authors: Elham Afghani; Stephen J Pandol; Tooru Shimosegawa; Robert Sutton; Bechien U Wu; Santhi Swaroop Vege; Fred Gorelick; Morihisa Hirota; John Windsor; Simon K Lo; Martin L Freeman; Markus M Lerch; Yoshihisa Tsuji; Gil Y Melmed; Wahid Wassef; Julia Mayerle Journal: Pancreas Date: 2015-11 Impact factor: 3.327
Authors: Pawan Noel; Krutika Patel; Chandra Durgampudi; Ram N Trivedi; Cristiane de Oliveira; Michael D Crowell; Rahul Pannala; Kenneth Lee; Randall Brand; Jennifer Chennat; Adam Slivka; Georgios I Papachristou; Asif Khalid; David C Whitcomb; James P DeLany; Rachel A Cline; Chathur Acharya; Deepthi Jaligama; Faris M Murad; Dhiraj Yadav; Sarah Navina; Vijay P Singh Journal: Gut Date: 2014-12-10 Impact factor: 23.059
Authors: Krutika Patel; Ram N Trivedi; Chandra Durgampudi; Pawan Noel; Rachel A Cline; James P DeLany; Sarah Navina; Vijay P Singh Journal: Am J Pathol Date: 2015-01-08 Impact factor: 4.307
Authors: Janneke van Grinsven; Sandra van Brunschot; Mark C van Baal; Marc G Besselink; Paul Fockens; Harry van Goor; Hjalmar C van Santvoort; Thomas L Bollen Journal: J Gastrointest Surg Date: 2018-05-11 Impact factor: 3.452