Advertisement

Quantification of the impact of interventional radiology in the management of acute pancreatitis

  • Holly J. ActonEmail author
  • Douglas Mulholland
  • William C. Torreggiani
Original Article

Abstract

Objectives

Interventional radiology plays a central role in the management of complicated acute pancreatitis, contributing to image-guided drainages, treating haemorrhagic complications and maintaining the patency of the biliary tree. In addition, many of these patients require long-term venous access for antibiotics or parenteral feeding. The aim of this study was to evaluate the role and level of involvement of the interventional radiology in this sub-group of patients.

Methods

This was a single-centre retrospective review of all admissions for acute pancreatitis over a 5-year period. Each case was assessed to determine whether radiological intervention was utilised.

Results

Our review included 401 patients. A total of 18.7% (75/401) of patients required vascular access procedures and 18.4% (74/401) required image-guided drainage. A total of 1.2% (2/401) patients had embolisation procedures performed. The embolisation procedures were performed to treat a pseudoaneurysm that had formed.

Overall, 20.9% (84/401) of patients were referred to the interventional radiology department for a procedure; a majority of these patients were referred for multiple procedures over the course of their admission. The patients in the ‘severe pancreatitis’ category had a total of 154 procedures performed, which was 65.5% of the total procedures. On average, the patients who underwent multiple interventional procedures tended to have a longer admission and more complex disease.

Conclusion

The diagnosis and treatment of complicated acute pancreatitis is heavily dependent on the interventional radiology department. A substantial proportion of patients with pancreatitis required radiological intervention as part of their management, the proportion of which increased significantly in complex disease.

Keywords

Acute pancreatitis Embolisation Image-guided drainage Interventional radiology Pseudoaneurysm Pseudocyst 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV (2016) Revised Atlanta classification for acute pancreatitis: a pictorial essay. Radiographics 36(3):675–687CrossRefGoogle Scholar
  2. 2.
    Thoeni RF (2012) The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262(3):751–764CrossRefGoogle Scholar
  3. 3.
    Maher MM, Lucey BC, Gervais DA, Mueller PR (2004) Acute pancreatitis: the role of imaging and interventional radiology. Cardiovasc Intervent Radiol 27(3):208–225CrossRefGoogle Scholar
  4. 4.
    van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck C, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling G, Karsten T, Hesselink EJ, van Laarhoven C, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen M, Buskens E, Gooszen HG, Dutch Pancreatitis Study Group (2010) A step-up approach or open Necrosectomy for necrotizing pancreatitis. N Engl J Med 362(16):1491–1502CrossRefGoogle Scholar
  5. 5.
    Rasch S, Phillip V, Reichel S, Rau B, Zapf C, Rosendahl J, Halm U, Zachäus M, Müller M, Kleger A, Neesse A, Hampe J, Ellrichmann M, Rückert F, Strauß P, Arlt A, Ellenrieder V, Gress TM, Hartwig W, Klar E, Mössner J, Post S, Schmid RM, Seufferlein T, Siech M, Werner J, Will U, Algül H (2016) Open surgical versus minimal invasive Necrosectomy of the pancreas-a retrospective multicenter analysis of the German pancreatitis study group. PLoS One 11(9):e0163651CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Barge JU, Lopera JE (2012) Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol 13(Suppl 1):S45–S55CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Kirby JM, Vora P, Midia M, Rawlinson J (2008) Vascular complications of pancreatitis: imaging and intervention. Cardiovasc Intervent Radiol 31(5):957–970CrossRefGoogle Scholar
  8. 8.
    Zabicki B, Limphaibool N, Holstad MJV, Juszkat R (2018) Endovascular management of pancreatitis-related pseudoaneurysms: a review of techniques. PLoS One 13(1):e0191998CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Kim DB, Chung WC, Lee JM, Lee K-M, Oh JH, Jeon EJ (2017) Analysis of factors associated with the severity of acute pancreatitis according to etiology. Gastroenterol Res Pract 2017:1219464PubMedCentralGoogle Scholar
  10. 10.
    Weitz G, Woitalla J, Wellhöner P, Schmidt K, Büning J, Fellermann K (2015) Does etiology of acute pancreatitis matter? A review of 391 consecutive episodes. JOP 16(2):171–175Google Scholar
  11. 11.
    Kemppainen E, Puolakkainen P (2007) Non-alcoholic etiologies of acute pancreatitis - exclusion of other etiologic factors besides alcohol and gallstones. Pancreatology 7(2–3):142–146CrossRefGoogle Scholar
  12. 12.
    Abu-El-Haija M, El-Dika S, Hinton A, Conwell DL (2018) Acute pancreatitis admission trends: a National Estimate through the kids’ inpatient database. J Pediatr 194:147–151.e1CrossRefGoogle Scholar
  13. 13.
    Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA, Yadav D, Petrov MS (2016) Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 1(1):45–55CrossRefGoogle Scholar
  14. 14.
    Krishna SG, Kamboj AK, Hart PA, Hinton A, Conwell DL (2017) The changing epidemiology of acute pancreatitis hospitalizations: a decade of trends and the impact of chronic pancreatitis. Pancreas 46(4):482–488CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Bausch D, Wellner U, Kahl S, Kuesters S, Richter-Schrag H-J, Utzolino S, Hopt UT, Keck T, Fischer A (2012) Minimally invasive operations for acute necrotizing pancreatitis: comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy. Surgery 152(3 Suppl 1):S128–S134CrossRefGoogle Scholar
  16. 16.
    Pintado M-C, Trascasa M, Arenillas C, de Zárate YO, Pardo A, Blandino Ortiz A, de Pablo R (2016) New Atlanta classification of acute pancreatitis in intensive care unit: complications and prognosis. Eur J Intern Med 30:82–87CrossRefGoogle Scholar
  17. 17.
    Garg PK, Sharma M, Madan K, Sahni P, Banerjee D, Goyal R (2010) Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis. Clin Gastroenterol Hepatol 8(12):1089–1094.e2CrossRefGoogle Scholar
  18. 18.
    Elke G, van Zanten ARH, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, Jiang X, Day AG, Heyland DK (2016) Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care 20(1):117CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Rinninella E, Annetta MG, Serricchio ML, Dal Lago AA, Miggiano GAD, Mele MC (2017) Nutritional support in acute pancreatitis: from physiopathology to practice. An evidence-based approach. Eur Rev Med Pharmacol Sci 21(2):421–432Google Scholar
  20. 20.
    Stigliano S, Sternby H, de Madaria E, Capurso G, Petrov MS (2017) Early management of acute pancreatitis: a review of the best evidence. Dig Liver Dis 49(6):585–594CrossRefGoogle Scholar
  21. 21.
    Bakker OJ, van Brunschot S, Farre A, Johnson CD, Kalfarentzos F, Louie BE, Oláh A, O'Keefe SJ, Petrov MS, Powell JJ, Besselink MG, van Santvoort HC, Rovers MM, Gooszen HG (2014) Timing of enteral nutrition in acute pancreatitis: meta-analysis of individuals using a single-arm of randomised trials. Pancreatology 14(5):340–346CrossRefGoogle Scholar
  22. 22.
    Marik PE, Zaloga GP (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ 328(7453):1407CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Morató O, Poves I, Ilzarbe L, Radosevic A, Vázquez-Sánchez A, Sánchez-Parrilla J, Burdío F, Grande L (2018) Minimally invasive surgery in the era of step-up approach for treatment of severe acute pancreatitis. Int J Surg 51:164–169CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Trinity College DublinSt James’s HospitalDublin 8Ireland
  2. 2.Department of RadiologyBeaumont HospitalDublin 9Ireland
  3. 3.Department of RadiologyTallaght University HospitalDublin 24Ireland

Personalised recommendations