Skip to main content

Advertisement

SpringerLink
Log in

Safety and efficacy of early image-guided percutaneous interventions in acute severe necrotizing pancreatitis: A single-center retrospective study

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Acute necrotizing pancreatitis is managed conservatively in early phase of the disease. Even minimally invasive procedure is preferred after 21 days of onset and there is a paucity of data on decision and outcomes of early radiological interventions. This study aimed to evaluate efficacy and safety of early image-guided percutaneous interventions in management of acute severe necrotizing pancreatitis.

Methods

A single-center retrospective study was performed after obtaining Institutional review board approval for analyzing hospital records of patients with acute necrotizing pancreatitis from January 2012 to July 2017. Seventy-eight consecutive patients with necrotizing pancreatitis and acute necrotic collections (ANC) were managed with percutaneous catheter drainage (PCD) and catheter-directed necrosectomy, in early phase of the disease (< 21 days). Clinical data and laboratory parameters of the included patients were evaluated until discharge from hospital, or mortality.

Results

Overall survival rate was 73.1%. Forty-two (53.8%) patients survived with PCD alone, while the remaining 15 (19.2%) survivors needed additional necrosectomy. The timing of intervention from the start of the hospitalization to drainage was 14.3 ± 2.4 days. Significant risk factors for mortality were the presence of organ system failure, need for mechanical ventilation, renal replacement therapy, and the acute physiology and chronic health evaluation II (APACHE II) score. An APACHE II score cutoff value of 15 was a significant discriminant for predicting survival with catheter-directed necrosectomy.

Conclusion

An early PCD of ANC in clinically deteriorating patients with acute necrotizing pancreatitis, along with aggressive catheter-directed necrosectomy can avoid surgical interventions, and improve outcome in a significant proportion of patients with acute necrotizing pancreatitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Besselink MG, van Santvoort HC, Nieuwenhuijs VB, et al. Minimally invasive ‘step-up approach’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006;6:6.

    Article  Google Scholar 

  2. Banks PA. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 1997;92:377–86.

    CAS  PubMed  Google Scholar 

  3. Uhl W, Warshaw A, Imrie C, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2:565–73.

  4. Rau B, Uhl W, Buchler MW, Beger HG. Surgical treatment of infected necrosis. World J Surg. 1997;21:155–61.

    Article  CAS  Google Scholar 

  5. Frey CF, Bradley EL 3rd, Beger HG. Progress in acute pancreatitis. Surg Gynecol Obstet. 1988;167:282–6.

    CAS  PubMed  Google Scholar 

  6. Beger HG, I senmann R. Surgical management of necrotizing pancreatitis. Surg Clin North Am. 1999;79:783–800.

  7. Tsiotos GG, Luque-de León E, Söreide JA, et al. Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. Am J Surg. 1998;175:91–8.

  8. D’Egidio A, Schein M. Surgical strategies in the treatment of pancreatic necrosis and infection. Br J Surg. 1991;78:133–7.

  9. Tsiotos GG, Luque-de León E, Sarr MG. Long-term outcome of necrotizing pancreatitis treated by necrosectomy. Br J Surg. 1998;85:1650–3.

  10. Van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg. 2011;98:18–27.

    Article  Google Scholar 

  11. Zerem E, Imamović G, Sušić A, Haračić B. Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre. Dig Liver Dis. 2011;43:478–83.

  12. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.

  13. Baudin G, Chassang M, Gelsi E, et al. CT-guided percutaneous catheter drainage of acute infectious necrotizing pancreatitis: assessment of effectiveness and safety. AJR Am J Roentgenol. 2012;199:192–9.

  14. Chen GY, Dai RW, Luo H, et al. Effect of percutaneous catheter drainage on pancreatic injury in rats with severe acute pancreatitis induced by sodium taurocholate. Pancreatology. 2015;15:71–7.

  15. Kotán R, Sápy P, Sipka S, et al. Serum C-reactive protein and white blood cell level as markers of successful percutaneous drainage of acute sterile peripancreatic fluid collection. Chirurgia. 2015;110:56–9.

    PubMed  Google Scholar 

  16. Bradley EL III. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128:586–90.

  17. Echenique AM, Sleeman D, Yrizarry J, et al. Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients. J Vasc Interv Radiol. 1998;9:565–71.

  18. Mortelé KJ, Girshman J, Szejnfeld D, et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol. 2009;192:110–6.

  19. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol. 1998;170:969–75.

  20. Baril NB, Ralls PW, Wren SM, et al. Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg. 2000;231:361–7.

  21. Navalho M, Pires F, Duarte A, Gonçalves A, Alexandrino P, Távora I. Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging. 2006;30:114–1.

    Article  Google Scholar 

  22. Bruennler T, Langgartner J, Lang S, et al. Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter? World J Gastroenterol. 2008;14:725–30.

    Article  CAS  Google Scholar 

  23. Babu RY, Gupta R, Kang M, Bhasin DK, Rana SS, Singh R. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg. 2013;257:737–50.

    Article  Google Scholar 

  24. Liu WH, Wang T, Yan HT, et al. Predictors of percutaneous catheter drainage (PCD) after abdominal paracentesis drainage (APD) in patients with moderately severe or severe acute pancreatitis along with fluid collections. PLoS One. 2015;10:e0115348.

  25. Hollemans RA, Bollen TL, van Brunschot S. Dutch Pancreatitis Study Group. Predicting success of catheter drainage in infected necrotizing pancreatitis. Ann Surg. 2016;263:787–92.

    Article  Google Scholar 

  26. Li A, Cao F, Li J, et al. Step-up mini-invasive surgery for infected pancreatic necrosis: results from prospective cohort study. Pancreatology. 2016;16:508–14.

  27. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet. 2018;391:51–8.

  28. Raghuwanshi S, Gupta R, Vyas MM, Sharma R. CT evaluation of acute pancreatitis and its prognostic correlation with CT severity index. J Clin Diagn Res. 2016;10:TC06–11.

  29. Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ. Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg. 2005;201:497–502.

Download references

Author information

Authors and Affiliations

  1. Interventional Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India

    Amar Mukund & Nishant Singla

  2. Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India

    Amar Mukund & Yashwant Patidar

  3. Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India

    Vikram Bhatia & Shiv Kumar Sarin

  4. Department of HPB Surgery, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India

    Asit Arora

Authors
  1. Amar Mukund
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nishant Singla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vikram Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Asit Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yashwant Patidar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shiv Kumar Sarin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amar Mukund.

Ethics declarations

Conflict of interest

AM, NS, VB, AA, YP, and SKS declare that they have no conflict of interest.

Ethics statement

The study was performed in amanner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com. The study was conducted after obtaining proper ethical clearance from the institutional ethics committee.

IRB statement

Approval for the study was obtained from institutional review board.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/ findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mukund, A., Singla, N., Bhatia, V. et al. Safety and efficacy of early image-guided percutaneous interventions in acute severe necrotizing pancreatitis: A single-center retrospective study. Indian J Gastroenterol 38, 480–487 (2019). https://doi.org/10.1007/s12664-019-00969-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-019-00969-0

Keywords

Search

Navigation