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Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Objectives

To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage (PCD) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments.

Methods

Eighty-one patients with severe acute pancreatitis (SAP) were admitted and divided into three groups: forty-nine cases in the conservative therapy group; nineteen cases in the surgery group; and thirteen cases in the PCD therapy group. Forty-five patients with a CT severity index (CTSI) ≤ 8.0 received conservative treatment. One patient with CTSI = 7.0 underwent surgery. Thirty-five patients with a CTSI > 8.0 were randomly selected for surgery or PCD treatment. After randomization, six patients (four patients in the surgery group and two patients in the PCD group) were dropped from the study. The total number of patients included in the surgery and PCD groups was sixteen and thirteen, respectively.

Results

Four patients (8.2%) in the conservative therapy group died, five patients (31.3%) in surgery group with a CTSI > 8.0 died, and all patients in the PCD group survived. The mortality rate was lower in the PCD group than in the surgery group (P = 0.048). The serum C-reactive protein (CRP) level recovered more quickly in patients in the PCD group compared to those in the surgery group (P < 0.001).

Conclusions

Patients with SAP and a CTSI ≤ 8.0 could be treated with conservative therapy, while patients with a CTSI > 8.0 should be treated with surgery or PCD therapy if the life-threatening complications of extensive fluid collection or necrosis are a factor. However, PCD therapy used in a timely manner for drainage may decrease mortality in patients with SAP, decrease inflammatory mediator release, and avoid incidence of severe sepsis or acute respiratory distress syndrome (ARDS) and emergency surgery.

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Acknowledgments

We thank Professor Stefano Fanti at The University of Bologna, Italy for assisting with the translation of our manscript into English. We are also grateful to the following organizations for their support: the National Health Key Special Fund (200802112); the Health Department Fund (2007A093, 2007A 094); the Traditional Chinese Medicine Bureau Fund (2007ZA019); and the Natural Science Fund of Zhejiang Province (Y208001).

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Authors and Affiliations

  1. Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88# Jiefang Road, 310009, Hangzhou, China

    Xinbo Ai, Wensheng Pan & Wen Hu

  2. Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 310009, Hangzhou, China

    Xiaoping Qian

  3. Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang University School of Medicine, 310009, Hangzhou, China

    Jun Xu

  4. Terai Clinic, Tokyo, 101-0021, Japan

    Takeshi Terai

  5. Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo, 113-8431, Japan

    Nobuhiro Sato & Sumio Watanabe

Authors
  1. Xinbo Ai
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  2. Xiaoping Qian
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  3. Wensheng Pan
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  4. Jun Xu
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  5. Wen Hu
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  6. Takeshi Terai
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  7. Nobuhiro Sato
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  8. Sumio Watanabe
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Corresponding author

Correspondence to Wensheng Pan.

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Ai, X., Qian, X., Pan, W. et al. Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis. J Gastroenterol 45, 77–85 (2010). https://doi.org/10.1007/s00535-009-0129-4

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  • DOI: https://doi.org/10.1007/s00535-009-0129-4

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