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Surgical Endoscopy

, Volume 29, Issue 11, pp 3282–3291 | Cite as

A percutaneous drainage protocol for severe and moderately severe acute pancreatitis

  • Motokazu SugimotoEmail author
  • David P. Sonntag
  • Greggory S. Flint
  • Cody J. Boyce
  • John C. Kirkham
  • Tyler J. Harris
  • Sean M. Carr
  • Brent D. Nelson
  • Joshua G. Barton
  • L. William Traverso
Article

Abstract

Background

According to the revised Atlanta classification, severe and moderately severe acute pancreatitis (AP) includes patients with pancreatic and peripancreatic collections with or without organ failure. These collections suggest the presence of pancreatic juice leakage. The aim of this study was to evaluate the efficacy of a percutaneous catheter drainage (PCD) protocol designed to control leakage and decrease disease severity.

Methods

Among 663 patients with clinical AP, 122 were classified as moderately severe or severe AP (all had collections). The computed tomography severity index (CTSI) score was calculated. The indication for PCD was based on progressive clinical signs and symptoms. Drain patency, position, and need for additional drainage sites were assessed using CT scans and drain studies initially every 3 days using a proactive protocol. Drain fluid was examined for amylase concentration and microbiological culture. Clinicopathological variables for patients with and without PCD were compared. Since there was no mortality, we used prolonged drainage time to measure the success of PCD. Within the group treated with PCD, variables that resulted in prolonged drainage time were analyzed.

Results

PCD was used in 47/122 (39 %) patients of which 33/47 (70 %) had necrosis. PCD cases had a median CTSI of 8 and were classified as moderately severe AP (57 %) and severe AP (43 %). Inhospital mortality was zero. Surgical necrosectomy was not required for patients with necrosis. Independent risk factors for prolonged drainage time were persistent organ failure >48 h (P = 0.001), CTSI 8–10 (P = 0.038), prolonged duration of amylase-rich fluid in drains (P < 0.001), and polymicrobial culture fluid in drains (P = 0.015).

Conclusions

A proactive PCD protocol persistently maintaining drain patency advanced to the site of leak controlled the prolonged amylase in drainage fluid resulting in a mortality rate of zero.

Keywords

Drainage Pancreatitis Treatment outcome Pancreatic fistula Necrosis Pancreatic juice 

Notes

Acknowledgments

The authors wish to express special thanks for statistical support to Richard Remington.

Disclosures

Motokazu Sugimoto, David P. Sonntag, Greggory S. Flint, Cody J. Boyce, John C. Kirkham, Tyler J. Harris, Sean M. Carr, Brent D. Nelson, Joshua G. Barton, and L. William Traverso have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Motokazu Sugimoto
    • 1
    Email author
  • David P. Sonntag
    • 2
  • Greggory S. Flint
    • 1
  • Cody J. Boyce
    • 3
  • John C. Kirkham
    • 3
  • Tyler J. Harris
    • 2
  • Sean M. Carr
    • 2
  • Brent D. Nelson
    • 2
  • Joshua G. Barton
    • 1
  • L. William Traverso
    • 1
  1. 1.Center for Pancreatic and Liver DiseaseSt. Luke’s Health SystemBoiseUSA
  2. 2.Department of Interventional RadiologySt. Luke’s Health SystemBoiseUSA
  3. 3.Department of Diagnostic RadiologySt. Luke’s Health SystemBoiseUSA

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