Format

Send to

Choose Destination
HPB (Oxford). 2015 Oct 17. doi: 10.1111/hpb.12491. [Epub ahead of print]

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study.

Author information

1
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
2
Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, the Netherlands.
3
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
4
Department of Radiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
5
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
6
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands.
7
Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
8
Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands.
9
Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
10
Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
11
Department of OR/Evidence Based Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
12
Department of Surgery, University of Washington Medical Center, Seattle, WA, USA.
13
Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.

Abstract

BACKGROUND:

The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis are subject to debate. A survey was performed on these topics amongst a group of international expert pancreatologists.

METHODS:

An online survey including case vignettes was sent to 118 international pancreatologists. The use and timing of fine-needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy were evaluated.

RESULTS:

The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. A lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention versus 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention versus 41% non-invasive).

DISCUSSION:

The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.

PMID:
26475650
DOI:
10.1111/hpb.12491

Supplemental Content

Loading ...
Support Center