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Minimally Invasive Management of Pancreatic Abscess, Pseudocyst, and Necrosis: A Systematic Review of Current Guidelines

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Abstract

Background

Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although there are no randomised trials to evaluate these techniques. The aims of this study were to review the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis and identify the degree of consensus between guidelines.

Methods

A MEDLINE search was performed to identify current guidelines from any professional body published in the English language. Guidelines were analysed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis.

Results

Sixteen guidelines were reviewed. Percutaneous catheter drainage for pancreatic abscess was recommended by eight guidelines; for infected pseudocysts, one guideline did not recommend its use and six recommended its use; for infected necrosis, two guidelines did not recommend its use and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis, endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.

Conclusions

Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst, and infected necrosis, and few recommendations were graded according to the strength of the evidence. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.

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Acknowledgments

Benjamin Loveday was supported by a Clinical Research Training Fellowship from the Health Research Council of New Zealand. Anubhav Mittal was supported by the Royal Australasian College of Surgeons Foundation New Zealand Research Fellowship.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand

    Benjamin P. T. Loveday, Anubhav Mittal, Anthony Phillips & John A. Windsor

  2. School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand

    Anthony Phillips

  3. HBP/Upper GI Unit, Department of Surgery, Auckland City Hospital, Auckland, New Zealand

    John A. Windsor

Authors
  1. Benjamin P. T. Loveday
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  2. Anubhav Mittal
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  3. Anthony Phillips
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  4. John A. Windsor
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Correspondence to John A. Windsor.

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Loveday, B.P.T., Mittal, A., Phillips, A. et al. Minimally Invasive Management of Pancreatic Abscess, Pseudocyst, and Necrosis: A Systematic Review of Current Guidelines. World J Surg 32, 2383–2394 (2008). https://doi.org/10.1007/s00268-008-9701-y

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