학술논문
Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study
Document Type
Academic Journal
Author
van Grinsven, Janneke; van Brunschot, Sandra; Bakker, Olaf J.; Bollen, Thomas L.; Boermeester, Marja A.; Bruno, Marco J.; Dejong, Cornelis H.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Fockens, Paul; van Goor, Harry; Gooszen, Hein G.; Horvath, Karen D.; van Lienden, Krijn P.; van Santvoort, Hjalmar C.; Besselink, Marc G.; Abdelhafez, M; Andersson, R; Andren-Sandberg, A; Ashley, S; van Baal, M; Baron, T; Bassi, C; Bradley, E; Buchler, M; Cappendijk, V; Carter, R; Charnley, R; Coelho, D; Connor, S; Dellinger, P; Dervenis, C; Deviere, J; Doctor, N; Dudeja, V; En-qiang, M; Escourrou, J; Fagenholz, P; Farkas, G; Forsmark, C; Freeman, M; Freeny, P; French, J; Friess, H; Gardner, T; Goetzinger, P; Haveman, J; Hofker, S; Imrie, C; Isaji, S; Isenmann, R; Klar, E; Laméris, J; Lerch, M; Lévy, P; Lillemoe, K; Löhr, M; Mayerle, J; Mayumi, T; Mittal, A; Moessner, J; Morgan, D; Mortele, K; Nealon, W; Neoptolemos, J; Nieuwenhuijs, V; Nordback, I; Olah, A; Oppong, K; Padbury, R; Papachristou, G; Parks, R; Poley, J; Radenkovic, D; Raraty, M; Rau, B; Rebours, V; Rische, S; Runzi, M; Sainani, N; Sarr, M; Schaapherder, S; Seewald, S; Seifert, H; Shimosegawa, T; Silverman, S; Singh, V; Siriwardena, A; Steinberg, W; Sutton, R; Takeda, K; Timmer, R; Vege, S; Voermans, R; de Waele, J; Wang, Ch; Warshaw, A; Werner, J; Weusten, B; Whitcomb, D; Wig, J; Windsor, J; Zyromski, N
Source
The Official Journal of The International Hepato Pancreato Biliary Association. Oct 20, 2015
Subject
Language
English
ISSN
1365-182X
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.