Pancreatitis

 

 

Reference Type:  Journal Article

Record Number: 5040Author: Solanki, R., Thumma, V., Sastry, R. A. and Bheerappa, N.

Year: 2013

Title: The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis

Journal: Trop Gastroenterol

Volume: 34

Issue: 1

Pages: 25-30

Date: Jan-Mar

Short Title: The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis

Alternate Journal: Tropical gastroenterology : official journal of the Digestive Diseases Foundation

ISSN: 0250-636X (Print)

0250-636X (Linking)

Accession Number: 23923371

Keywords: Adult

Debridement/methods

Female

Follow-Up Studies

Humans

Male

Pancreatitis, Acute Necrotizing/*surgery

Retrospective Studies

Suction/*methods

Surgery, Computer-Assisted/*methods

*Tomography, X-Ray Computed

Treatment Outcome

Abstract: BACKGROUND: Percutaneous catheter drainage (PCD) has become popular as a minimally invasive technique in the treatment armamentarium of patients with necrotizing pancreatitis requiring intervention. It obviates surgery and its attendant morbidity in a considerable number of patients in this setting. AIM: The aim of the study was to examine whether PCD upfront avoids surgery in a cohort of patients with necrotizing pancreatitis requiring intervention, and to identify factors predicting its failure. METHODS: We retrospectively reviewed demographic, clinical, and perioperative details of patients with severe acute pancreatitis from January 2009 to December 2011. Of 40 patients with necrotizing pancreatitis admitted to the surgical gastroenterology unit at our institute, 23 patients requiring PCD or surgical intervention were included in this study. Patients with successful and failed PCD were compared to identify factors predictive of failure of PCD. We also compared patients undergoing open necroseotomy with those undergoing PCD upfront, and open necrosectomy in terms of major complications including death. RESULTS: . Surgery was avoided in 7/23 (30%) patients with necrotizing pancreatitis who underwent PCD upfront. Higher APACHE II score (p=0.003) and extent of intrapancreatic necrosis (> 50%, p=0.03) were statistically significant predictors of failure of PCD. Although the complications were not different in patients undergoing PCD upfront followed by surgery, they had lower APACHE II and SOFA scores after PCD and had resolution of organ failures. CONCLUSIONS: PCD obviates surgery or acts as a temporizing measure in a significant number of patients with necrotizing pancreatitis. APACHE II scores and extent of intrapancreatic necrosis are principle factors determining success of PCD.

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