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

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Janneke van GrinsvenDutch Pancreatitis Study Group

Abstract

The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy. 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. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive). The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amon...Continue Reading

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Citations

Feb 15, 2017·Pancreas·Janneke van GrinsvenUNKNOWN Dutch Pancreatitis Study Group
Oct 12, 2017·Revista do Colégio Brasileiro de Cirurgiões·Roberto RasslanSamir Rasslan
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