Skip to main content
SpringerLink
Log in

Randomized controlled trial on sterile fluid collections management in acute pancreatitis: should they be removed?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objective

To evaluate if percutaneous drainage of sterile fluid collections recurring after initial aspiration in acute pancreatitis yields better results than their conservative management.

Methods

Fifty-eight patients with fluid collections in acute pancreatitis were followed up prospectively. Forty of them with sterile fluid collections that recurred after initial aspiration were randomly assigned to two groups of 20 in each. One group was initially treated with conservative management and the other group with prolonged catheter drainage. Patients with unsuccessful initial treatment were converted to more aggressive procedure. Outcome measure was conversion rate to more aggressive procedure.

Results

Conversion to more aggressive procedure was done in 11 and 3 patients treated conservatively and with catheter drainage, respectively (p = 0.02). Four and 11 patients had bacterial colonization of their fluid collections in conservative management and drainage group, respectively (p = 0.048). Conservative treatment was successful in all six patients with sterile liquid collections < 30 ml. However, this treatment was unsuccessful in all seven patients with multiloculated and liquid collections >100 ml.

Conclusions

Prolonged catheter drainage is more efficient for management of recurrent sterile fluid collections in acute pancreatitis than is conservative treatment. Conservative treatment is successful for patients with small fluid collections.

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

Similar content being viewed by others

References

  1. Bradley EL III (1993) A clinical based classification system for acute pancreatitis. Summary or the International Symposium on Acute Pancreatitis, Atlanta Ga, Septembar 11–13 1992. Arch Surg 128:586–590

    PubMed  Google Scholar 

  2. Chen WX, Li YM, Gao DJ et al (2005) Application of endoscopic sphincterotomy in acute pancreatitis with fluid collection: a prospective study. World J Gastroenterol 11:3636–3639

    PubMed  Google Scholar 

  3. Balthazar EJ, Freeny PC, vanSonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193:297–306

    CAS  PubMed  Google Scholar 

  4. Walser EM, Nealon WH, Marroquin S et al (2006) Sterile fluid collections in acute pancreatitis: catheter drainage versus simple aspiration. Cardiovasc Intervent Radiol 29:102–107

    Article  PubMed  Google Scholar 

  5. Büchler MW, Gloor B, Müller CA et al (2000) Acute necrotizing pancreatitis: strategy according to the status of infection. Ann Surg 232:619–626

    Article  PubMed  Google Scholar 

  6. Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–613

    Article  PubMed  Google Scholar 

  7. Liu LR, Xia SH (2006) Role of platelet-activating factor in pathogenesis of acute pancreatitis. World J Gastroenterol 12:539–545

    CAS  PubMed  Google Scholar 

  8. Zerem E, Muminhodžić K, Smajić M (2002) Interventional ultrasound in the treatment of acute pancreatitis. Med Arch 56:31–32

    Google Scholar 

  9. Fotoohi M, D’Agostino HB, Wollman B et al (1999) Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology 213:573–578

    CAS  PubMed  Google Scholar 

  10. Kariniemi J, Sequeiros RB, Ojala R et al (2006) Feasibility of MR imaging-guided percutaneous drainage of pancreatic fluid collections. J Vasc Interv Radiol 17:1321–1326

    Article  PubMed  Google Scholar 

  11. Dugernier T, Pf Laterre, Reynaert MS (2000) Ascites fluid in severe acute pancreatitis: from pathophysiology to therapy. Acta Gastroenterol Belg 63:264–268

    CAS  PubMed  Google Scholar 

  12. Arvanitakis M, Delhaye M, Bali MA et al (2007) Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 65:609–619

    Article  PubMed  Google Scholar 

  13. Tenner S (2004) Initial management of acute pancreatitis:critical issues during the first 72 hours. Am J Gastroenterol 99:2489–2494

    Article  PubMed  Google Scholar 

  14. Werner J, Feuerbach S, Uhl W et al (2005) Management of acute pancreatitis: from surgery to interventional intensive care. Gut 54:426–436

    Article  CAS  PubMed  Google Scholar 

  15. Runkel NS, Moody FG, Smith GS et al (1991) The role of the gut in the development of sepsis in acute pancreatitis. J Surg Res 51(1):18–23

    Article  CAS  PubMed  Google Scholar 

  16. Marotta F, Geng TC, Wu CC et al (1996) Bacterial translocation in the course of acute pancreatitis: beneficial role of nonabsorbable antibiotics and lactitol enemas. Digestion 57(6):446–452

    Article  CAS  PubMed  Google Scholar 

  17. Tenner S, Sicca G, Hughes M et al (1997) Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 113(3):899–903

    Article  CAS  PubMed  Google Scholar 

  18. Freeny PC, Hauptmann E, Althaus SJ et al (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170:969–975

    CAS  PubMed  Google Scholar 

  19. Bruennier T, Langgartner J, Lang S et al (2008) Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter? World J Gastroenterol 14:725–730

    Article  Google Scholar 

  20. Xie-Ning W (1998) Management of severe acute pancreatitis. World J Gastroenterol 4(1):90–91

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The University Clinical Center Tuzla, Trnovac bb, Tuzla, Bosnia and Herzegovina

    Enver Zerem & Goran Imamovic

  2. General Hospital Mostar, Mostar, Bosnia and Herzegovina

    Safet Omerović & Bilal Imširović

Authors
  1. Enver Zerem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Goran Imamovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Safet Omerović
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bilal Imširović
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enver Zerem.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zerem, E., Imamovic, G., Omerović, S. et al. Randomized controlled trial on sterile fluid collections management in acute pancreatitis: should they be removed?. Surg Endosc 23, 2770–2777 (2009). https://doi.org/10.1007/s00464-009-0487-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0487-2

Keywords

Search

Navigation