Indian Journal of Surgery

, Volume 78, Issue 3, pp 221–228 | Cite as

Percutaneous Catheter Drainage in Infected Pancreatitis Necrosis: a Systematic Review

  • Lichi Ke
  • Junhua Li
  • Peihong Hu
  • Lianqun Wang
  • Haiming ChenEmail author
  • Yaping Zhu
Review Article


The primary aim of this study was to present the outcomes of percutaneous catheter drainage (PCD) in patients with infected pancreatitis necrosis. A second aim was to focus on disease severity, catheter size, and additional surgical intervention. A literature search of the PubMed/MEDLINE/Cochrane Library (January 1998 to February 2015) databases was conducted. All randomized, non-randomized, and retrospective studies with data on PCD techniques and outcomes in patients with infected pancreatitis necrosis were included. Studies that reported data on PCD along with other interventions without the possibility to discriminate results specific to PCD were excluded. The main outcomes were mortality, major complications, and definitive successful treatment with percutaneous catheter drainage alone. Fifteen studies of 577 patients were included. There was only one randomized, controlled trial, and most others were retrospective case series. Organ failure before PCD occurred in 55.3 % of patients. With PCD alone, definitive successful treatment was 56.2 % of patients. Additional surgical intervention was required after PCD in 38.5 % of patients. The overall mortality rate was 18 % (104 of 577 patients). Complications occurred in 25.1 % of patients, and fistula was the most common complication. PCD is an efficient tool for treatment in the majority of patients with infected pancreatitis necrosis as the only intervention. Multiple organ failures before PCD are negative parameters for the outcome of the disease. Large catheters fail to prove to be more effective for draining necrotic tissue. However, in the extent of multi-morbid patients, to determine one single prognostic factor seems to be difficult.


Infected pancreatitis necrosis Percutaneous catheter drainage Intervention Systematic 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ et al (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143(5):1179–1187CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed AU, Schrijver AM et al (2011) A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141(4):1254–1263CrossRefPubMedGoogle Scholar
  3. 3.
    Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA (2010) Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 139(3):813–820CrossRefPubMedGoogle Scholar
  4. 4.
    Bello B, Matthews JB (2012) Minimally invasive treatment of pancreatic necrosis. World J Gastroenterol 18(4):6829–6835CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rau B, Bothe A, Beger HG (2005) Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 138(1):28–39CrossRefPubMedGoogle Scholar
  6. 6.
    Rodriguez JR, Razo AO, Targarona J, Thayer SP, Rattner DW, Warshaw AL et al (2008) Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 247(2):294–299CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Tsiotos GG, Luque-de LE, Sarr MG (1998) Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg 85(12):1650–1653CrossRefPubMedGoogle Scholar
  8. 8.
    van Santvoort HC, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Laméris JS更K et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. New England J Med 362(16):1491–1502Google Scholar
  9. 9.
    Baron TH, Thaggard WG, Morgan DE, Stanley RJ (1996) Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 111(3):755–764CrossRefPubMedGoogle Scholar
  10. 10.
    Echenique AM, Sleeman D, Yrizarry J, Scagnelli T, Guerra JJ, Casillas VJ et al (1998) Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Interv Radiol 9(4):565–571CrossRefPubMedGoogle Scholar
  11. 11.
    Zorger N, Hamer OW, Feuerbach S, Borisch I (2005) Percutaneous treatment of a patient with infected necrotizing pancreatitis. Nat Clin Pract Gastroenterol Hepatol 2(1):54–57, 58CrossRefPubMedGoogle Scholar
  12. 12.
    Gmeinwieser J, Holstege A, Zirngibl H, Palitzsch KD, Hugl S, Strotzer M et al (2000) Successful percutaneous treatment of infected necrosis of the body of the pancreas associated with segmental disruption of the main pancreatic duct. Gastrointest Endosc 52(3):413–415CrossRefPubMedGoogle Scholar
  13. 13.
    Cheung MT, Ho CN, Siu KW, Kwok PC (2005) Percutaneous drainage and necrosectomy in the management of pancreatic necrosis. ANZ J Surg 75(4):204–207CrossRefPubMedGoogle Scholar
  14. 14.
    Szentkereszty Z, Kerekes L, Hallay J, Czako D, Sapy P (2002) CT-guided percutaneous peripancreatic drainage: a possible therapy in acute necrotizing pancreatitis. Hepatogastroenterology 49(48):1696–1698PubMedGoogle Scholar
  15. 15.
    Besselink MG, van Santvoort HC, Schaapherder AF, van Ramshorst B, van Goor H, Gooszen HG (2007) Feasibility of minimally invasive approaches in patients with infected necrotizing pancreatitis. Br J Surg 94(5):604–608CrossRefPubMedGoogle Scholar
  16. 16.
    Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170(4):969–975CrossRefPubMedGoogle Scholar
  17. 17.
    Hollemans RA, Bollen TL, van Brunschot S, Bakker OJ, Ahmed Ali U, van Goor H et al (2015) Predicting success of catheter drainage in infected necrotizing pancreatitis. Ann Surg, 1Google Scholar
  18. 18.
    Hollemans RA, van Brunschot S, Bakker OJ, Bollen TL, Timmer R, Besselink MG et al (2014) Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Rev Med Devices 11(6):637–648CrossRefPubMedGoogle Scholar
  19. 19.
    Tong ZH, Li WQ, Yu WK, Wang XY, Ye XH, Nie Y et al (2010) The clinical effectiveness of percutaneous drainage and laparotomy for patients with infective pancreatic necrosis. Zhonghua Wai Ke Za Zhi 48(18):1387–1391PubMedGoogle Scholar
  20. 20.
    Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139(1):69–81PubMedGoogle Scholar
  21. 21.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRefPubMedGoogle Scholar
  22. 22.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174(2):331–336CrossRefPubMedGoogle Scholar
  23. 23.
    Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN et al (2004) A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol 183(5):1261–1265CrossRefPubMedGoogle Scholar
  24. 24.
    Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM (1985) Acute pancreatitis: prognostic value of CT. Radiology 156(3):767–772CrossRefPubMedGoogle Scholar
  25. 25.
    Fotoohi M, D’Agostino HB, Wollman B, Chon K, Shahrokni S, VanSonnenberg E (1999) Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology 213(2):573–578CrossRefPubMedGoogle Scholar
  26. 26.
    Baril NB, Ralls PW, Wren SM, Selby RR, Radin R, Parekh D et al (2000) Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg 231(3):361–367CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Navalho M, Pires F, Duarte A, Gonçalves A, Alexandrino P, Távora I (2006) Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging 30(2):114–119CrossRefPubMedGoogle Scholar
  28. 28.
    Bruennler T, Langgartner J, Lang S, Wrede CE, Klebl F, Zierhut S et al (2008) Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter? World J Gastroenterol 14(5):725–730CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mortele KJ, Girshman J, Szejnfeld D, Ashley SW, Erturk SM, Banks PA et al (2009) CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol 192(1):110–116CrossRefPubMedGoogle Scholar
  30. 30.
    Rocha FG, Benoit E, Zinner MJ, Whang EE, Banks PA, Ashley SW et al (2009) Impact of radiologic intervention on mortality in necrotizing pancreatitis: the role of organ failure. Arch Surg 144(3):261–265CrossRefPubMedGoogle Scholar
  31. 31.
    Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ et al (2010) Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg 145(9):817–825CrossRefPubMedGoogle Scholar
  32. 32.
    Baudin G, Chassang M, Gelsi E, Novellas S, Bernardin G, Hebuterne X et al (2012) CT-guided percutaneous catheter drainage of acute infectious necrotizing pancreatitis: assessment of effectiveness and safety. AJR Am J Roentgenol 199(1):192–199CrossRefPubMedGoogle Scholar
  33. 33.
    Zerem E, Imamović G, Sušić A, Haračić B (2011) Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre. Dig Liver Dis 43(6):478–483CrossRefPubMedGoogle Scholar
  34. 34.
    Tong Z, Li W, Yu W, Geng Y, Ke L, Nie Y et al (2012) Percutaneous catheter drainage for infective pancreatic necrosis: is it always the first choice for all patients? Pancreas 41(2):302–305CrossRefPubMedGoogle Scholar
  35. 35.
    Wroński M, Cebulski W, Karkocha D, Słodkowski M, Wysocki Ł, Jankowski M et al (2013) Ultrasound-guided percutaneous drainage of infected pancreatic necrosis. Surg Endosc 27(8):2841–2848CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Solanki R, Thumma V, Sastry RA, Bheerappa N (2013) The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis. Trop Gastroenterol 34(1):25–30CrossRefPubMedGoogle Scholar
  37. 37.
    (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13, e1-e15Google Scholar
  38. 38.
    Tenner S, Sica G, Hughes M, Noordhoek E, Feng S, Zinner M et al (1997) Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 113(3):899–903CrossRefPubMedGoogle Scholar
  39. 39.
    Perez A, Whang EE, Brooks DC, Moore FJ, Hughes MD, Sica GT et al (2002) Is severity of necrotizing pancreatitis increased in extended necrosis and infected necrosis? Pancreas 25(3):229–233CrossRefPubMedGoogle Scholar
  40. 40.
    Zhu AJ, Shi JS, Sun XJ (2003) Organ failure associated with severe acute pancreatitis. World J Gastroenterol 9(11):2570–2573PubMedPubMedCentralGoogle Scholar
  41. 41.
    Johnson CD, Abu-Hilal M (2004) Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut 53(9):1340–1344CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Howard TJ, Patel JB, Zyromski N, Sandrasegaran K, Yu J, Nakeeb A et al (2007) Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg 11(1):43–49CrossRefPubMedGoogle Scholar
  43. 43.
    Connor S, Alexakis N, Raraty MG, Ghaneh P, Evans J, Hughes M et al (2005) Early and late complications after pancreatic necrosectomy. Surgery 137(5):499–505CrossRefPubMedGoogle Scholar
  44. 44.
    van Brunschot S, Fockens P, Bakker OJ, Besselink MG, Voermans RP, Poley J et al (2014) Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 28(5):1425–1438CrossRefPubMedGoogle Scholar
  45. 45.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354(9193):1896–1900CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2016

Authors and Affiliations

  • Lichi Ke
    • 1
  • Junhua Li
    • 1
  • Peihong Hu
    • 1
  • Lianqun Wang
    • 1
  • Haiming Chen
    • 1
    Email author
  • Yaping Zhu
    • 2
  1. 1.Department of SurgeryThe First Affiliated Hospital of Nanchang UniversityNanchangPeople’s Republic of China
  2. 2.Department of SurgeryThe Zhuhai Hospital of Jinan UniversityZhuhaiPeople’s Republic of China

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