Skip to main content
SpringerLink
Log in

Natural History of Gas Configurations and Encapsulation in Necrotic Collections During Necrotizing Pancreatitis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Decision-making on invasive intervention in patients with clinical signs of infected necrotizing pancreatitis is often related to the presence of gas configurations and the degree of encapsulation in necrotic collections on imaging. Data on the natural history of gas configurations and encapsulation in necrotizing pancreatitis are, however, lacking.

Methods

A post hoc analysis was performed of a previously described prospective cohort in 21 Dutch hospitals (2004–2008). All computed tomography scans (CTs) performed during hospitalization for necrotizing pancreatitis were categorized per week (1 to 8, and thereafter) and re-assessed by an abdominal radiologist.

Results

A total of 639 patients with necrotizing pancreatitis were included, with median four (IQR 2–7) CTs per patient. The incidence of first onset of gas configurations varied per week without a linear correlation: 2–3–13–11–10–19–12–21–12%, respectively. Overall, gas configurations were found in 113/639 (18%) patients and in 113/202 (56%) patients with infected necrosis. The incidence of walled-off necrosis increased per week: 0–3–12–39–62–76–93–97–100% for weeks 1–8 and thereafter respectively. Clinically relevant walled-off necrosis (largely or fully encapsulated necrotic collections) was seen in 162/379 (43%) patients within the first 3 weeks.

Conclusions

Gas configurations occur in every phase of the disease and develop in half of the patients with infected necrotizing pancreatitis. Opposed to traditional views, clinically relevant walled-off necrosis occurs frequently within the first 3 weeks.

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
Fig. 4

Similar content being viewed by others

References

  1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179-87e1-3

    Article  PubMed  PubMed Central  Google Scholar 

  2. Beger HG, Rau B, Mayer J, et al. Natural course of acute pancreatitis. World J Surg 1997;21:130–135

    Article  PubMed  CAS  Google Scholar 

  3. 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;128:586–590

    Article  PubMed  Google Scholar 

  4. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102–111

    Article  PubMed  Google Scholar 

  5. Working group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13:e1–15

    Article  Google Scholar 

  6. Tenner S, Baillie J, DeWitt J, et al; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013;108:1400–1415

    Article  PubMed  CAS  Google Scholar 

  7. Van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–1502

    Article  PubMed  Google Scholar 

  8. Van Grinsven J, van Brunschot S, Bakker OJ, et al. Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study. HPB (Oxford) 2016;18:49–56

    Article  Google Scholar 

  9. Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011; 141:1254–1263

    Article  PubMed  Google Scholar 

  10. Van Baal MC, Bollen TL, Bakker OJ, et al. The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis. Surgery. 2014;155:442–448

    Article  PubMed  Google Scholar 

  11. Kwong WT, Ondrejková A, Vege SS. Predictors and outcomes of moderately severe acute pancreatitis - Evidence to reclassify. Pancreatology. 2016;16:940–945

    Article  PubMed  Google Scholar 

  12. Cui ML, Kim KH, Kim HG, et al. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci. 2014;59:1055–1062

    Article  PubMed  Google Scholar 

  13. Sarathi Patra P, Das K, Bhattacharyya A, et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg. 2014;101:1721–1728

    Article  PubMed  CAS  Google Scholar 

  14. Poornachandra KS, Bhasin DK, Nagi B, et al. Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis. J Clin Gastroenterol. 2011;45:159–163

    Article  PubMed  Google Scholar 

  15. Rana SS, Bhasin DK, Reddy YK, et al. Morphological features of fluid collections on endoscopic ultrasound in acute necrotizing pancreatitis: do they change over time? Ann Gastroenterol. 2014;27:258–261

    PubMed  PubMed Central  Google Scholar 

  16. Bakker OJ, van Santvoort H, Besselink MG, et al. Extrapancreatic necrosis without pancreatic parenchymal necrosis: a separate entity in necrotising pancreatitis? Gut. 2013;62:1475–1480

    Article  PubMed  Google Scholar 

  17. Hollemans RA, Bollen TL, van Brunschot S, et al. Predicting Success of Catheter Drainage in Infected Necrotizing Pancreatitis. Ann Surg. 2016;263:787–792

    Article  PubMed  Google Scholar 

  18. Bouwense SA, van Brunschot S, van Santvoort HC et al. Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study. Pancreas. 2017;46:850–857

    Article  PubMed  Google Scholar 

  19. Fernández-del Castillo C, Rattner DW, Makary MA, et al. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg. 1998;228:676–684

    Article  PubMed  PubMed Central  Google Scholar 

  20. Besselink MG, Verwer TJ, Schoenmaeckers EJ, Timing of surgical intervention in necrotizing pancreatitis. Arch Surg. 2007;142:1194–1201

    Article  PubMed  Google Scholar 

  21. Mier J, León EL, Castillo A, et al. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg. 1997;173:71–75

    Article  PubMed  CAS  Google Scholar 

  22. Van Baal MC, van Santvoort HC, Bollen TL, et al. Dutch Pancreatitis Study Group. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011;98:18–27

  23. Van Grinsven J, Timmerman P, van Lienden KP, et al. Proactive Versus Standard Percutaneous Catheter Drainage for Infected Necrotizing Pancreatitis. Pancreas. 2017;46:518–523

    Article  PubMed  Google Scholar 

  24. Sugimoto M, Sonntag DP, Flint GS, et al. Better Outcomes if Percutaneous Drainage Is Used Early and Proactively in the Course of Necrotizing Pancreatitis. J Vasc Interv Radiol 2016;27:418–425

    Article  PubMed  Google Scholar 

Download references

Funding

Parts of this research were funded by Fonds NutsOhra, the Netherlands, grant number 1404-044.

Author information

Author notes

  1. Janneke van Grinsven and Sandra van Brunschot contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

    Janneke van Grinsven & Marc G. Besselink

  2. Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands

    Janneke van Grinsven & Hjalmar C. van Santvoort

  3. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, Amsterdam, the Netherlands

    Sandra van Brunschot & Paul Fockens

  4. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands

    Sandra van Brunschot, Mark C. van Baal & Hjalmar C. van Santvoort

  5. Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands

    Harry van Goor

  6. Department of Radiology, St. Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, the Netherlands

    Thomas L. Bollen

Authors
  1. Janneke van Grinsven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra van Brunschot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark C. van Baal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc G. Besselink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Fockens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harry van Goor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hjalmar C. van Santvoort
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas L. Bollen
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Dutch Pancreatitis Study Group

Contributions

TLB designed the study protocol and evaluated the CTs. MGB and HCvS collected the clinical data. JvG, SvB, and MCvB collected and analyzed the data. JvG drafted and revised the manuscript. SvB, MCvB, MGB, PF, HvG, HCvS, and TLB critically edited the manuscript and approved the final version.

Corresponding authors

Correspondence to Janneke van Grinsven or Thomas L. Bollen.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Grinsven, J., van Brunschot, S., van Baal, M.C. et al. Natural History of Gas Configurations and Encapsulation in Necrotic Collections During Necrotizing Pancreatitis. J Gastrointest Surg 22, 1557–1564 (2018). https://doi.org/10.1007/s11605-018-3792-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-018-3792-z

Keywords

Search

Navigation