CT-Guided Percutaneous Catheter Drainage of Acute Infectious Necrotizing Pancreatitis: Assessment of Effectiveness and Safety (original) (raw)
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Journal of the Pancreas, 2019
Objective The purpose of the study is to select & assess the effectiveness of computed tomography Guided percutaneous drainage in patients with pancreatitis according to the clinical and imaging parameters. Materials and Methods The study was performed from January 2012 to January 2017. The study included 126 consecutive patients (103 men and 23 women; median age 39 years) with necrotizing pancreatitis who underwent percutaneous catheter drainage via computed tomography guidance and were evaluated according to the clinical criteria, radiological scores, drainage and catheter characteristics, and complications. A retrospective review of our cross-sectional interventional radiology database over 60 months (5 years) identified all patients who underwent primary computed tomography-guided percutaneous drainage for acute necrotizing pancreatitis. Results Successful percutaneous drainage outcome was achieved in 108 of 126 patients (85.7%). No surgery was required in 95 patients (75%). Of these 108 patients, 13 patients had the liquefiable part of the collection drained by percutaneous drainage, but the phlegmon caused persistent sepsis, and had to undergo elective surgical necrosectomy. Rest of the 18 patients did not have a successful outcome on percutaneous drainage; of these, 16 patients had treatment failure on percutaneous drainage then surgery was performed, and 2 patients passed away with treatment failure on percutaneous drainage and surgery. The procedurerelated complications were observed in six patients of which one had hemorrhage due to the catheter eroding the vessel and five had a pancreatico-cutaneous fistula. Of the total 126 patients, 110 patients were managed as outpatients with regular clinic visits. Conclusion Percutaneous catheter drainage is a safe and effective technique for treating infected acute necrotizing pancreatitis. Appropriate selection of patients should be performed to maximize the benefit of percutaneous procedures. Treating necrotizing pancreatitis requires dedicated multidisciplinary team efforts from the physicians, surgeons, radiologist and the drain management team.
Polish Journal of Radiology, 2021
Purpose: Acute pancreatitis is commonly complicated by the development of pancreatic collections (PCs). Symptomatic PCs warrant drainage, and the available options include percutaneous, endoscopic, and open surgical approaches. The study aimed to assess the therapeutic effectiveness and safety of image guided percutaneous catheter drainage (PCD) in the management of acute pancreatitis related PCs. Material and methods: This was a single-centre prospective study covering a 4-year study period. Acute pancreatitisrelated PCs complicated by secondary infection or those producing symptoms due to pressure effect on surrounding structures were enrolled and underwent ultrasound or computed tomography (CT)-guided PCD. The patients were followed to assess the success of PCD (defined as clinical, radiological improvement, and the avoidance of surgery) and any PCD-related complications. Results: The study included 60 patients (60% males) with a mean age of 43.1 ± 21.2 years. PCD recorded a success rate of 80% (16/20) for acute peripancreatic fluid collections (APFC) and pancreatic pseudocysts (PPs), 75% (12/16) for walled-off necrosis (WON), and 50% (12/24) for acute necrotic collections (ANCs). Post-PCD surgery (necrosectomy ± distal pancreatectomy) was needed in 50% of ANC and 25% of WON. Only 20% of APFCs/PPs patients required surgical/endoscopic treatment post-PCD. Minor procedure-related complications were seen in 4 (6.6%) patients. Conclusion: PCD is an effective, safe, and minimally invasive therapeutic modality with a good success rate in the management of infected/symptomatic PCs.
European Radiology, 2019
Purpose To assess interobserver agreement when using the revised Atlanta classification (RAC) to categorize pancreatic and peripancreatic collections during the first month of acute pancreatitis (AP), and to correlate type of collection to outcome. Material and methods This retrospective study of 115 consecutive patients admitted for 123 AP episodes, 178 CTs performed within the first month showed peripancreatic abnormalities. Each AP episode was classified as mild, moderately severe, or severe based on the RAC. Two radiologists, blinded to clinical data, used RAC criteria to retrospectively categorize the collections as acute peripancreatic fluid collections (APFC) or acute necrotic collections (ANC). Interobserver agreement was assessed based on Cohen's κ statistics and compared according to CT timing. Results Interobserver agreement for categorizing peripancreatic collections was moderate (κ = 0.45) and did not improve with time to CT (κ values, 0.53 < day 3, 0.34 on days 3-6, and 0.43 ≥ day 7). For detecting parenchymal necrosis, interobserver agreement was also moderate (κ = 0.45). AP was less severe in patients with APFC versus ANC (p = 0.04). Conclusion Our finding of moderate interobserver agreement when using the RAC to categorize pancreatic and peripancreatic collections by CT indicates that the accurate diagnosis of APFC or ANC by CT in the first 4 weeks after symptom onset is often challenging. Key Points • Interobserver agreement was moderate for categorizing peripancreatic collections. • Interobserver agreement did not improve with time from onset to CT. • Interobserver agreement was moderate for detecting parenchymal necrosis. Keywords Acute necrotizing pancreatitis. Multidetector computed tomography. Interobserver variability. Outcomes assessment. Pancreatitis Abbreviations ANC Acute necrotic collection AP Acute pancreatitis APFC Acute peripancreatic fluid collection CT Computed tomography IEP Interstitial edematous pancreatitis RAC Revised Atlanta classification WON Walled-off necrosis
Impact of the site of necrosis on outcome of acute pancreatitis
JGH Open, 2018
Objecives: To compare the clinical outcome of patients with extrapancreatic necrosis (EXPN) alone with that of acute interstitial pancreatitis (AIP), pancreatic parenchymal necrosis (PPN) alone, and combined PPN and EXPN. Background: There are only a few studies in the literature in which EXPN has been recently recognized as a subtype of acute necrotizing pancreatitis (ANP), with a better prognosis. Methods: We analyzed clinical data and outcome variables of 411 consecutive acute pancreatitis (AP) patients between January 2012 and December 2014. Contrastenhanced computed tomography (CECT) images of each patient were reviewed and characterized as AIP or ANP. Patients with ANP were divided into EXPN alone, PPN alone, and combined PPN and EXPN. Outcome variables were then compared between these groups. Results: Of the 411 patients, 74 (18%) had AIP, and 337 (82%) had ANP. Patients with EXPN alone (n = 40; 11.8%) had similar outcomes as patients with PPN alone (n = 12; 3.5%); however, their outcome was worse than that of patients with AIP, with a higher frequency of persistent organ failure (POF), need for percutaneous catheter drainage (PCD), and longer length of hospitalization (LOH). Patients with combined PPN and EXPN (n = 285; 84.7%) had the worst clinical course, with higher frequency of POF, infected necrosis, intervention requirement, and longer LOH. Conclusion: Patients with combined PPN and EXPN have a severe disease course with the worst clinical outcomes; patients with AIP patients have the most benign course, while patients with EXPN alone stand between the two extremes of disease course with an intermediate grade of severity.
Cureus
Introduction Open necrosectomy in acute infected necrotizing pancreatitis is associated with very high mortality and morbidity. Moreover, if it is performed before four weeks, the benefits are limited. In this study, we evaluated the safety and efficacy of percutaneous catheter drainage (PCD) in patients with acute infected necrotizing pancreatitis. Methods It was a single-center, observational study, where all consecutive patients with proven or probable infected acute necrotizing pancreatitis in whom PCD was performed were studied. The patients who failed to respond to PCD underwent open necrosectomy. Baseline characteristics and the outcome of all included patients, including complications of PCD, were studied. Results A total of 46 patients (males=36, females=10) underwent PCD over a period of 18 months. Fifteen (32.60%) patients succumbed to their illness. PCD benefitted a total of 31 (67.39%) patients; in 17 (36.95%) patients, it worked as a standalone therapy, while in 14 (30.43%) patients, additional surgery was required where it helped to delay the surgery. Median days at which PCD and surgery were performed were 17.5 days (range: 2-28 days) and 33 days (range: 7-70 days), respectively. Lower mean arterial pressure at presentation, presence of multiorgan failure, more than 50% necrosis, higher baseline creatinine and bilirubin levels, and an early surgery were markers of increased mortality. Three (6.5%) patients had PCD-related complications, out of which only one required active intervention. Conclusion PCD in infected acute pancreatic necrosis is safe and effective. In one-third of the patients, it worked as standalone therapy, and in the rest it delayed the surgery beyond four weeks, thereby preventing the complications associated with early aggressive debridement.
Impact of Radiologic Intervention on Mortality in Necrotizing Pancreatitis
Archives of Surgery, 2009
Background: Our group previously reported that organ failure and mortality in necrotizing pancreatitis (NP) are not different between patients with infected and sterile necrosis. Since that report, management of this disease has evolved to include image-guided percutaneous catheter drainage (PCD) to improve morbidity and mortality. We evaluated the effect of PCD on mortality in NP. Design: Retrospective analysis. Setting: Tertiary care referral center. Patients: A total of 689 consecutive patients treated for acute pancreatitis between 2001 and 2005, of whom 64 (9.3%) had pancreatic necrosis documented on contrastenhanced computed tomography. Main Outcome Measures: Mortality and organ failure. Results: In the 64 patients with documented NP, overall mortality was 16%. Thirty-six patients (56%) had organ failure according to the Atlanta classification. Compared with patients with sterile necrosis, those with infected necrosis did not have an increased prevalence of organ failure or increased need for intubation, pressors, or dialysis but had an increased mortality. Mortality in patients treated conservatively was 1 of 29 (3%); in those with PCD alone, 6 of 11 (55%); in those with PCD and surgery, 2 of 17 (12%); and in those with surgery alone, 1 of 7 (14%). All patients treated with PCD alone had organ failure, whereas 10 (59%) of those with PCD and surgery had organ failure. Conclusion: The use of PCD did not improve the mortality of NP among patients with organ failure.
Gastroenterology report, 2014
Background: Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear.
Percutaneous Catheter Drainage for Infective Pancreatic Necrosis
Pancreas, 2012
To learn the clinical outcome of percutaneous catheter drainage (PCD) for patients with infective pancreatic necrosis and the possible influencing factors. Methods: A retrospective review of medical records of patients with infective pancreatic necrosis who received PCD as the first choice for treatment in the recent 2 years. The patients were divided into 2 groups: (1) PCD success group and (2) PCD alteration group. Characteristics, complications, and PCD process were compared. Results: In this study, 19 of 34 patients were cured by PCD alone (55.9%), whereas open necrosectomy were needed for 15 patients (44.1%). Between these 2 groups, most baseline and clinical characteristics did not show any statistical difference, including the number and size of catheter used and the bacterial culture result. The PCD alteration group had higher mean computed tomographic density (P = 0.012) and larger distribution range of infected pancreatic necrosis (4.53 T 1.35 vs 5.93 T 1.62; P = 0.009) than the PCD success group (P G 0.01). The logistic regression analysis revealed the same facts. Conclusion: The mean computed tomographic density and distribution range of infective pancreatic necrosis could significantly influence the success rate of PCD; higher values of them indicate less appropriate for PCD; thus, it should be considered seriously before the treatment decision.