BACKGROUND: Infected pancreatic necrosis (IPN) is a major complication of acute pancreatitis (AP), which may require necrosectomy. Minimally invasive surgical step-up therapy is preferred for IPN. AIM: To assess the effectiveness of percutaneous endoscopic step-up therapy in patients with IPN and identify predictors of its success. METHODS: Consecutive patients with AP hospitalized to our tertiary care academic center were studied prospectively. Patients with IPN formed the study group. The treatment protocol for IPN was percutaneous endoscopic step-up approach starting with antibiotics and percutaneous catheter drainage, and if required necrosectomy. Percutaneous endoscopic necrosectomy (PEN) was performed using a flexible endoscope through the percutaneous tract under conscious sedation. Control of sepsis with resolution of collection(s) was the primary outcome measure. RESULTS: A total of 415 patients with AP were included. Of them, 272 patients had necrotizing pancreatitis and 177 (65%) developed IPN. Of these 177 patients, 27 were treated conservatively with antibiotics alone, 56 underwent percutaneous drainage alone, 53 required underwent PEN as a step-up therapy, 1 per-oral endoscopic necrosectomy, and 52 required surgery. Of the 53 patients in the PEN group, 42 (79.2%) were treated successfully-34 after PEN alone and 8 after additional surgery. Eleven of 53 patients died due to organ failure-7 after PEN and 4 after surgery. Independent predictors of mortality were > 50% necrosis and early organ failure. CONCLUSION: Percutaneous endoscopic step-up therapy is an effective strategy for IPN. Organ failure and extensive pancreatic necrosis predicted a suboptimal outcome in patients with infected necrotizing pancreatitis.
BACKGROUND:Infected pancreatic necrosis (IPN) is a major complication of acute pancreatitis (AP), which may require necrosectomy. Minimally invasive surgical step-up therapy is preferred for IPN. AIM: To assess the effectiveness of percutaneous endoscopic step-up therapy in patients with IPN and identify predictors of its success. METHODS: Consecutive patients with AP hospitalized to our tertiary care academic center were studied prospectively. Patients with IPN formed the study group. The treatment protocol for IPN was percutaneous endoscopic step-up approach starting with antibiotics and percutaneous catheter drainage, and if required necrosectomy. Percutaneous endoscopic necrosectomy (PEN) was performed using a flexible endoscope through the percutaneous tract under conscious sedation. Control of sepsis with resolution of collection(s) was the primary outcome measure. RESULTS: A total of 415 patients with AP were included. Of them, 272 patients had necrotizing pancreatitis and 177 (65%) developed IPN. Of these 177 patients, 27 were treated conservatively with antibiotics alone, 56 underwent percutaneous drainage alone, 53 required underwent PEN as a step-up therapy, 1 per-oral endoscopic necrosectomy, and 52 required surgery. Of the 53 patients in the PEN group, 42 (79.2%) were treated successfully-34 after PEN alone and 8 after additional surgery. Eleven of 53 patientsdied due to organ failure-7 after PEN and 4 after surgery. Independent predictors of mortality were > 50% necrosis and early organ failure. CONCLUSION: Percutaneous endoscopic step-up therapy is an effective strategy for IPN. Organ failure and extensive pancreatic necrosis predicted a suboptimal outcome in patients with infected necrotizing pancreatitis.
Authors: H Seifert; M Biermer; W Schmitt; C Jürgensen; U Will; R Gerlach; C Kreitmair; A Meining; T Wehrmann; T Rösch Journal: Gut Date: 2009-03-11 Impact factor: 23.059
Authors: Sandra van Brunschot; Janneke van Grinsven; Hjalmar C van Santvoort; Olaf J Bakker; Marc G Besselink; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Stefan A Bouwense; Marco J Bruno; Vincent C Cappendijk; Esther C Consten; Cornelis H Dejong; Casper H van Eijck; Willemien G Erkelens; Harry van Goor; Wilhelmina M U van Grevenstein; Jan-Willem Haveman; Sijbrand H Hofker; Jeroen M Jansen; Johan S Laméris; Krijn P van Lienden; Maarten A Meijssen; Chris J Mulder; Vincent B Nieuwenhuijs; Jan-Werner Poley; Rutger Quispel; Rogier J de Ridder; Tessa E Römkens; Joris J Scheepers; Nicolien J Schepers; Matthijs P Schwartz; Tom Seerden; B W Marcel Spanier; Jan Willem A Straathof; Marin Strijker; Robin Timmer; Niels G Venneman; Frank P Vleggaar; Rogier P Voermans; Ben J Witteman; Hein G Gooszen; Marcel G Dijkgraaf; Paul Fockens Journal: Lancet Date: 2017-11-03 Impact factor: 79.321
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