Step-up approach to infected necrotising pancreatitis: A 20-year experience of percutaneous drainage in a single centre

作者：Zerem Enver^*; Imamovic Goran; Susic Alma; Haracic Bahrija

来源：Digestive and Liver Disease, 2011, 43(6): 478-483.

DOI：10.1016/j.dld.2011.02.020

• Acute pancreatitis
• Infection
• Non-surgical treatment
• Pancreatic necrosis

Aim: To evaluate the efficacy of step-up approach to infected necrotising pancreatitis.
Methods: Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality.
Results: Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86(68.6%) and multiorgan failure in 25/86(29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9-47) and 15(7-34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient.
Conclusions: The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients.

• 出版日期2011-6