Safety and Efficacy of Early Image-guided Percutaneous Interventions in Acute Severe Necrotizing Pancreatitis: A Single-center Retrospective Study

Overview

Journal Indian J Gastroenterol

Specialty Gastroenterology

Date 2020 Feb 1

PMID 32002829

Citations 4

Authors

Amar Mukund

Nishant Singla

Vikram Bhatia

Asit Arora

Yashwant Patidar

Shiv Kumar Sarin

Affiliations

Soon will be listed here.

Abstract

Background: Acute necrotizing pancreatitis is managed conservatively in early phase of the disease. Even minimally invasive procedure is preferred after 21 days of onset and there is a paucity of data on decision and outcomes of early radiological interventions. This study aimed to evaluate efficacy and safety of early image-guided percutaneous interventions in management of acute severe necrotizing pancreatitis.

Methods: A single-center retrospective study was performed after obtaining Institutional review board approval for analyzing hospital records of patients with acute necrotizing pancreatitis from January 2012 to July 2017. Seventy-eight consecutive patients with necrotizing pancreatitis and acute necrotic collections (ANC) were managed with percutaneous catheter drainage (PCD) and catheter-directed necrosectomy, in early phase of the disease (< 21 days). Clinical data and laboratory parameters of the included patients were evaluated until discharge from hospital, or mortality.

Results: Overall survival rate was 73.1%. Forty-two (53.8%) patients survived with PCD alone, while the remaining 15 (19.2%) survivors needed additional necrosectomy. The timing of intervention from the start of the hospitalization to drainage was 14.3 ± 2.4 days. Significant risk factors for mortality were the presence of organ system failure, need for mechanical ventilation, renal replacement therapy, and the acute physiology and chronic health evaluation II (APACHE II) score. An APACHE II score cutoff value of 15 was a significant discriminant for predicting survival with catheter-directed necrosectomy.

Conclusion: An early PCD of ANC in clinically deteriorating patients with acute necrotizing pancreatitis, along with aggressive catheter-directed necrosectomy can avoid surgical interventions, and improve outcome in a significant proportion of patients with acute necrotizing pancreatitis.

Citing Articles

Post-intervention complications and management: Following percutaneous catheter drainage.

Kang M, Baloji A, Chowhan P Surg Open Sci. 2023; 14:5-8.

PMID: 37363773 PMC: 10285632. DOI: 10.1016/j.sopen.2023.06.002.

Early vs. late percutaneous catheter drainage of acute necrotic collections in patients with necrotizing pancreatitis.

Bhatia H, Farook S, Bendale C, Gupta P, Singh A, Shah J Abdom Radiol (NY). 2023; 48(7):2415-2424.

PMID: 37067560 DOI: 10.1007/s00261-023-03883-4.

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis.

Gupta P, Madhusudhan K, Padmanabhan A, Khera P Indian J Radiol Imaging. 2022; 32(3):339-354.

PMID: 36177275 PMC: 9514912. DOI: 10.1055/s-0042-1754313.

Drainage of pancreatic fluid collections in acute pancreatitis: A comprehensive overview.

Bansal A, Gupta P, Singh A, Shah J, Samanta J, Mandavdhare H World J Clin Cases. 2022; 10(20):6769-6783.

PMID: 36051118 PMC: 9297419. DOI: 10.12998/wjcc.v10.i20.6769.

References

Liu W, Wang T, Yan H, Chen T, Xu C, Ye P . Predictors of percutaneous catheter drainage (PCD) after abdominal paracentesis drainage (APD) in patients with moderately severe or severe acute pancreatitis along with fluid collections. PLoS One. 2015; 10(2):e0115348. PMC: 4319763. DOI: 10.1371/journal.pone.0115348. View

Tsiotos G, Luque-de Leon E, Sarr M . Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg. 1999; 85(12):1650-3. DOI: 10.1046/j.1365-2168.1998.00950.x. View

Raghuwanshi S, Gupta R, Vyas M, Sharma R . CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index. J Clin Diagn Res. 2016; 10(6):TC06-11. PMC: 4963736. DOI: 10.7860/JCDR/2016/19849.7934. View

Li A, Cao F, Li J, Fang Y, Wang X, Liu D . Step-up mini-invasive surgery for infected pancreatic necrosis: Results from prospective cohort study. Pancreatology. 2016; 16(4):508-14. DOI: 10.1016/j.pan.2016.03.014. View

van Brunschot S, van Grinsven J, van Santvoort H, Bakker O, Besselink M, Boermeester M . Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet. 2017; 391(10115):51-58. DOI: 10.1016/S0140-6736(17)32404-2. View

Echenique A, Sleeman D, Yrizarry J, Scagnelli T, Guerra Jr J, Casillas V . Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Interv Radiol. 1998; 9(4):565-71. DOI: 10.1016/s1051-0443(98)70323-9. View

Hollemans R, Bollen T, van Brunschot S, Bakker O, Ali U, Goor H . Predicting Success of Catheter Drainage in Infected Necrotizing Pancreatitis. Ann Surg. 2015; 263(4):787-92. DOI: 10.1097/SLA.0000000000001203. View

van Santvoort H, Besselink M, Bakker O, Hofker H, Boermeester M, Dejong C . A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010; 362(16):1491-502. DOI: 10.1056/NEJMoa0908821. View

Vriens P, van de Linde P, Slotema E, Warmerdam P, Breslau P . Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005; 201(4):497-502. DOI: 10.1016/j.jamcollsurg.2005.06.269. View

10.

Beger H, Isenmann R . Surgical management of necrotizing pancreatitis. Surg Clin North Am. 1999; 79(4):783-800, ix. DOI: 10.1016/s0039-6109(05)70043-8. View

11.

Rau B, Uhl W, Buchler M, Beger H . Surgical treatment of infected necrosis. World J Surg. 1997; 21(2):155-61. DOI: 10.1007/s002689900208. View

12.

Baudin G, Chassang M, Gelsi E, Novellas S, Bernardin G, Hebuterne X . CT-guided percutaneous catheter drainage of acute infectious necrotizing pancreatitis: assessment of effectiveness and safety. AJR Am J Roentgenol. 2012; 199(1):192-9. DOI: 10.2214/AJR.11.6984. View

13.

Freeny P, Hauptmann E, Althaus S, Traverso L, Sinanan M . Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol. 1998; 170(4):969-75. DOI: 10.2214/ajr.170.4.9530046. View

14.

Uhl W, Warshaw A, Imrie C, Bassi C, McKay C, Lankisch P . IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002; 2(6):565-73. DOI: 10.1159/000071269. View

15.

DEgidio A, SCHEIN M . Surgical strategies in the treatment of pancreatic necrosis and infection. Br J Surg. 1991; 78(2):133-7. DOI: 10.1002/bjs.1800780204. View

16.

Besselink M, van Santvoort H, Nieuwenhuijs V, Boermeester M, Bollen T, Buskens E . Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006; 6:6. PMC: 1508161. DOI: 10.1186/1471-2482-6-6. View

17.

Tsiotos G, Luque-de Leon E, Soreide J, Bannon M, Zietlow S, Sarr M . Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. Am J Surg. 1998; 175(2):91-8. DOI: 10.1016/s0002-9610(97)00277-8. View

18.

Kotan R, Sapy P, Sipka S, Damjanovich L, Kovacs D, Csiszko A . Serum C-reactive protein and white blood cell level as markers of successful percutaneous drainage of acute sterile peripancreatic fluid collection. Chirurgia (Bucur). 2015; 110(1):56-9. View

19.

Chen G, Dai R, Luo H, Liu W, Chen T, Lin N . Effect of percutaneous catheter drainage on pancreatic injury in rats with severe acute pancreatitis induced by sodium taurocholate. Pancreatology. 2014; 15(1):71-7. DOI: 10.1016/j.pan.2014.10.005. View

20.

Frey C, Bradley 3rd E, Beger H . Progress in acute pancreatitis. Surg Gynecol Obstet. 1988; 167(4):282-6. View