Janneke van Grinsven1, Sandra van Brunschot2, Olaf J Bakker3, Thomas L Bollen4, Marja A Boermeester5, Marco J Bruno6, Cornelis H Dejong7, Marcel G Dijkgraaf8, Casper H van Eijck9, Paul Fockens2, Harry van Goor10, Hein G Gooszen11, Karen D Horvath12, Krijn P van Lienden13, Hjalmar C van Santvoort14, Marc G Besselink15. 1. Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: j.van.grinsven@antoniusziekenhuis.nl. 2. Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 3. Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Dept. of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands. 5. Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 6. Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands. 7. Dept. of Surgery, Maastricht University Medical Center, Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, The Netherlands. 8. Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands. 9. Dept. of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 10. Dept. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 11. Dept. of OR/Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 12. Dept. of Surgery, University of Washington Medical Center, Seattle, United States. 13. Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands. 14. Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 15. Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
Abstract
BACKGROUND: The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. METHODS: An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy. RESULTS: The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive). DISCUSSION: The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.
BACKGROUND: The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. METHODS: An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy. RESULTS: The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive). DISCUSSION: The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.
Authors: Waldemar Uhl; Andrew Warshaw; Clement Imrie; Claudio Bassi; Colin J McKay; Paul G Lankisch; Ross Carter; Eugene Di Magno; Peter A Banks; David C Whitcomb; Christos Dervenis; Charles D Ulrich; Kat Satake; Paula Ghaneh; Werner Hartwig; Jens Werner; Gerry McEntee; John P Neoptolemos; Markus W Büchler Journal: Pancreatology Date: 2002 Impact factor: 3.996
Authors: T Bruennler; J Langgartner; S Lang; C E Wrede; F Klebl; S Zierhut; S Siebig; F Mandraka; F Rockmann; B Salzberger; S Feuerbach; J Schoelmerich; O W Hamer Journal: World J Gastroenterol Date: 2008-02-07 Impact factor: 5.742
Authors: Anne F Peery; Evan S Dellon; Jennifer Lund; Seth D Crockett; Christopher E McGowan; William J Bulsiewicz; Lisa M Gangarosa; Michelle T Thiny; Karyn Stizenberg; Douglas R Morgan; Yehuda Ringel; Hannah P Kim; Marco Dacosta DiBonaventura; Charlotte F Carroll; Jeffery K Allen; Suzanne F Cook; Robert S Sandler; Michael D Kappelman; Nicholas J Shaheen Journal: Gastroenterology Date: 2012-08-08 Impact factor: 22.682
Authors: Peter J Fagenholz; Carlos Fernández-del Castillo; N Stuart Harris; Andrea J Pelletier; Carlos A Camargo Journal: Pancreas Date: 2007-11 Impact factor: 3.327
Authors: J Ruben Rodriguez; A Oswaldo Razo; Javier Targarona; Sarah P Thayer; David W Rattner; Andrew L Warshaw; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2008-02 Impact factor: 12.969
Authors: Marc G H Besselink; Thomas J Verwer; Ernst J P Schoenmaeckers; Erik Buskens; Ben U Ridwan; Maarten R Visser; Vincent B Nieuwenhuijs; Hein G Gooszen Journal: Arch Surg Date: 2007-12
Authors: Thomas K Maatman; Mark A Heimberger; Kyle A Lewellen; Alexandra M Roch; Cameron L Colgate; Michael G House; Attila Nakeeb; Eugene P Ceppa; C Max Schmidt; Nicholas J Zyromski Journal: Can J Surg Date: 2020-05-21 Impact factor: 2.089
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
Authors: Max Heckler; Thilo Hackert; Kai Hu; Cristopher M Halloran; Markus W Büchler; John P Neoptolemos Journal: Langenbecks Arch Surg Date: 2020-09-10 Impact factor: 3.445
Authors: Xiaowu Dong; Wenjian Mao; Lu Ke; Lin Gao; Jing Zhou; Bo Ye; Gang Li; Anthony Phillips; Zhihui Tong; John Windsor; Weiqin Li Journal: Gastroenterol Res Pract Date: 2021-07-10 Impact factor: 2.260