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.
Original language | English |
---|---|
Pages (from-to) | 49-56 |
Number of pages | 8 |
Journal | HPB |
Volume | 18 |
Issue number | 1 |
Early online date | 17 Oct 2015 |
DOIs | |
Publication status | Published - Jan 2016 |
Keywords
- PERCUTANEOUS CATHETER DRAINAGE
- FINE-NEEDLE-ASPIRATION
- STEP-UP APPROACH
- UNITED-STATES
- NECROSECTOMY
- DEBRIDEMENT
- COLLECTIONS
- MULTICENTER
- MANAGEMENT
- OUTCOMES