Motokazu Sugimoto1, David P Sonntag2, Greggory S Flint3, Cody J Boyce4, John C Kirkham4, Tyler J Harris2, Sean M Carr2, Brent D Nelson2, Don A Bell2, Joshua G Barton3, L William Traverso3. 1. Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712. Electronic address: msugimot7@gmail.com. 2. Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712. 3. Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712. 4. Department of Diagnostic Radiology, St. Luke's Health System, , 100 E. Idaho St., Suite 301, Boise, ID 83712.
Abstract
PURPOSE: To compare outcomes after percutaneous catheter drainage (PCD) for acute necrotizing pancreatitis versus those in a randomized controlled trial as a reference standard. MATERIALS AND METHODS: Between September 2010 and August 2014, CT-guided PCD was the primary treatment for 39 consecutive patients with pancreatic necrosis. The indication for PCD was the clinical finding of uncontrolled pancreatic juice leakage rather than infected necrosis. Subsequent to PCD, the drains were proactively studied with fluoroscopic contrast medium every 3 days to ensure patency and position. Drains were ultimately maneuvered to the site of leakage. These 39 patients were compared with 43 patients from the Pancreatitis, Necrosectomy versus Step-up Approach (PANTER) trial. RESULTS: The CT severity index was similar between studies (median of 8 in each). Time from onset of acute pancreatitis to PCD was shorter in the present series (median, 23 d vs 30 d). The total number of procedures (PCD and subsequent fluoroscopic drain studies) per patient was greater in the present series (mean, 14 vs 2). More patients in the PANTER trial had organ failure (62% vs 84%), required open or endoscopic necrosectomy (0% vs 60%), and experienced in-hospital mortality (0% vs 19%; P < .05 for all). CONCLUSIONS: Even though patients in the present series had a similar CT severity index as those in the PANTER trial, the former group showed lower incidences of organ failure, need for necrosectomy, and in-hospital mortality. The use of a proactive PCD protocol early, before the development of severe sepsis, appeared to be effective.
RCT Entities:
PURPOSE: To compare outcomes after percutaneous catheter drainage (PCD) for acute necrotizing pancreatitis versus those in a randomized controlled trial as a reference standard. MATERIALS AND METHODS: Between September 2010 and August 2014, CT-guided PCD was the primary treatment for 39 consecutive patients with pancreatic necrosis. The indication for PCD was the clinical finding of uncontrolled pancreatic juice leakage rather than infected necrosis. Subsequent to PCD, the drains were proactively studied with fluoroscopic contrast medium every 3 days to ensure patency and position. Drains were ultimately maneuvered to the site of leakage. These 39 patients were compared with 43 patients from the Pancreatitis, Necrosectomy versus Step-up Approach (PANTER) trial. RESULTS: The CT severity index was similar between studies (median of 8 in each). Time from onset of acute pancreatitis to PCD was shorter in the present series (median, 23 d vs 30 d). The total number of procedures (PCD and subsequent fluoroscopic drain studies) per patient was greater in the present series (mean, 14 vs 2). More patients in the PANTER trial had organ failure (62% vs 84%), required open or endoscopic necrosectomy (0% vs 60%), and experienced in-hospital mortality (0% vs 19%; P < .05 for all). CONCLUSIONS: Even though patients in the present series had a similar CT severity index as those in the PANTER trial, the former group showed lower incidences of organ failure, need for necrosectomy, and in-hospital mortality. The use of a proactive PCD protocol early, before the development of severe sepsis, appeared to be effective.
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: Andrea Szentesi; Emese Tóth; Emese Bálint; Júlia Fanczal; Tamara Madácsy; Dorottya Laczkó; Imre Ignáth; Anita Balázs; Petra Pallagi; József Maléth; Zoltán Rakonczay; Balázs Kui; Dóra Illés; Katalin Márta; Ágnes Blaskó; Alexandra Demcsák; Andrea Párniczky; Gabriella Pár; Szilárd Gódi; Dóra Mosztbacher; Ákos Szücs; Adrienn Halász; Ferenc Izbéki; Nelli Farkas; Péter Hegyi Journal: PLoS One Date: 2016-10-24 Impact factor: 3.240