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Contemporary Intervention in Necrotizing Pancreatitis: Improved Understanding Changing Practice

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Treatment of necrotizing pancreatitis (NP) has shifted in favor of a minimally invasive step-up approach rather than early open pancreatic debridement. We hypothesized that this paradigm shift would be reflected in the intervention, morbidity, and mortality profile of NP patients.

Study Design

Single-institution retrospective review of 767 NP patients treated between 2005 and 2019. Two eras of NP intervention were identified relative to the introduction of a minimally invasive approach to NP. Patients treated between 2005 and 2010 were classified as the “early” group and compared with patients treated between 2011 and 2019, classified as the “late” group.

Results

In total, 299 NP patients comprised the early group and 468 patients comprised the late group. No differences were seen in patient demographics, comorbidity profile, or NP etiology between groups. Necrosis volume, necrosis location, CT severity index (CTSI), and rates of infected necrosis were similar between groups. No difference was seen in mortality. Mechanical intervention for NP was more common in the early than the late group (86% vs. 73%, p < 0.001). Time to first intervention was similar between groups (79 ± 7d vs. 75 ± 6d). The early group had higher rates of open pancreatic debridement (72% vs. 55%, p < 0.001). Endoscopic intervention was less common in the early than the late group (7% vs. 16%, p < 0.001). NP disease duration was longer in the early than the late group (223 ± 12d vs. 179 ± 7d, p = 0.001).

Conclusion

Contemporary management of necrotizing pancreatitis is marked by less frequent operative debridement and shorter disease duration.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson Hall 519, Indianapolis, IN, 46202, USA

    Sean P. McGuire, Thomas K. Maatman, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, Trang K. Nguyen, C. Max Schmidt & Nicholas J. Zyromski

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  1. Sean P. McGuire
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  2. Thomas K. Maatman
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  3. Eugene P. Ceppa
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  4. Michael G. House
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  5. Attila Nakeeb
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  6. Trang K. Nguyen
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  7. C. Max Schmidt
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  8. Nicholas J. Zyromski
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Contributions

SP McGuire and TK Maatman were involved in acquisition, analysis, and interpretation of data. SP McGuire and NJ Zyromski drafted and revised the manuscript. SP McGuire, TK Maatman, EP Ceppa, MG House, A Nakeeb, TK Nguyen, CM Schmidt, and NJ Zyromski were involved in the conception of the project, interpretation of the data, and revision of work. All authors were involved in the final approval. NJ Zyromski serves as the mentor and corresponding author and agrees to be accountable for the work.

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Correspondence to Nicholas J. Zyromski.

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† This work has been selected for presentation at the American College of Surgeons 107th Annual Clinical Congress, Scientific Forum, Washington, DC, October 2021

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McGuire, S.P., Maatman, T.K., Ceppa, E.P. et al. Contemporary Intervention in Necrotizing Pancreatitis: Improved Understanding Changing Practice. J Gastrointest Surg 26, 1445–1452 (2022). https://doi.org/10.1007/s11605-022-05285-1

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  • DOI: https://doi.org/10.1007/s11605-022-05285-1

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