We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Step-up approach for the treatment of infected necrotising pancreatitis: real life data from a single-centre experience with long-term follow-up.
- Authors
Valentin, Claire; Cosquer, Guillaume Le; Tuyeras, Géraud; Culetto, Adrian; Barange, Karl; Hervieu, Pierre-Emmanuel; Carrère, Nicolas; Muscari, Fabrice; Mokrane, Fatima; Otal, Philippe; Bournet, Barbara; Suc, Bertrand; Buscail, Louis
- Abstract
Background: About 20% of patients with acute pancreatitis develop a necrotising form with a worse prognosis due to frequent appearance of organ failure(s) and/or infection of necrosis. Aims of the present study was to evaluate the "step up" approach treatment of infected necrosis in terms of: feasibility, success in resolving infection, morbidity of procedures, risk factors associated with death and long-term sequels. Methods: In this observational retrospective monocentric study in the real life, necrotizing acute pancreatitis at the stage of infected walled-off necrosis were treated as follow: first step with drainage (radiologic and/or endoscopic-ultrasound-guided with lumen apposing metal stent); in case of failure, minimally invasive necrosectomy sessions(s) by endoscopy through the stent and/or via retroperitoneal surgery (step 2); If necessary open surgery as a third step. Efficacy was assessed upon to a composite clinical-biological criterion: resolution of organ failure(s), decrease of at least two of clinico-biological criteria among fever, CRP serum level, and leucocytes count). Results: Forty-one consecutive patients were treated. The step-up strategy: (i) was feasible in 100% of cases; (ii) allowed the infection to be resolved in 33 patients (80.5%); (iii) Morbidity was mild and rapidly resolutive; (iv) the mortality rate at 6 months was of 19.5% (significant factors: SIRS and one or more organ failure(s) at admission, fungal infection, size of the largest collection ≥ 16 cm). During the follow-up (median 72 months): 27% of patients developed an exocrine pancreatic insufficiency, 45% developed or worsened a previous diabetes, 24% had pancreatic fistula and one parietal hernia. Conclusions: Beside a very good feasibility, the step-up approach for treatment of infected necrotizing pancreatitis in the real life displays a clinico-biological efficacy in 80% of cases with acceptable morbidity, mortality and long-term sequels regarding the severity of the disease.
- Subjects
NECROTIZING pancreatitis; EXOCRINE pancreatic insufficiency; PANCREATITIS; PANCREATIC fistula; MYCOSES
- Publication
BMC Gastroenterology, 2024, Vol 24, Issue 1, p1
- ISSN
1471-230X
- Publication type
Article
- DOI
10.1186/s12876-024-03289-6