Upsizing versus non-upsizing percutaneous catheter drainage in (infected) necrotizing pancreatitis

Timmerman, P. (Pieter) (2014) Upsizing versus non-upsizing percutaneous catheter drainage in (infected) necrotizing pancreatitis. thesis, Medicine.

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Abstract

Background Necrotizing pancreatitis occurs in 20% of all acute pancreatitis patients. In 30% of those cases this is complicated by a secondary infection of the (peri)pancreatic necrotic collection, which is almost always an indication for intervention. Currently the surgical step-up approach is most used, consisting of first percutaneous catheter drainage (PCD), followed if necessary by a minimal invasive surgical necrosectomy. The aim of this study was to compare a PCD upsize strategy with a non-upsize strategy in the surgical step-up approach. Method A 10 year retrospective review of data (January 2004 till May 2014), containing patients who underwent PCD as primary treatment for infected necrotizing pancreatitis. Patients treated in a center that applied a drain upsize strategy were compared with those with a non upsize strategy. Our primary outcome is treatment with ‘successful PCD’. Secondary outcomes are mortality, need for additional necrosectomy, number of interventional procedures, total duration of PCD, duration of admission till first PCD, total hospital and intensive care stay and severe complications. Results Of all 1427 patients with acute pancreatitis, 369 (26%) patients were diagnosed with necrotizing pancreatitis. Of them 117 (32%) retrieved primary PCD for infected necrosis: 42 patients in a drain upsize strategy center, versus 75 patients in a non-drain upsize strategy center. After adjustments for differences between groups, patients in the upsize strategy group needed significantly less necrosectomies than the non-upsize strategy group ([OR], 2,54; 95% CI, 1.02-6.30; p=.045). Significant difference was seen on total amount of PCD procedures and maximal drain size between the two groups. No significant differences was seen on our primary outcome ‘successful PCD’ and mortality. Conclusion A PCD upsize strategy seems at least as safe and effective in patients with (suspected) infected necrotizing pancreatitis as a non-upsizing strategy and it may obviate an additional necrosectomy.

Item Type:	Thesis (Thesis)
Supervisor name:	Haveman, Dr. J.W.
Supervisor name:	Grinsven, Drs. J. van and St. Antonius Hospital, Nieuwegein and Besselink, Dr. M.G. and Academic Medical Center, Amsterdam
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:44
Last Modified:	25 Jun 2020 10:44
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/579

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