Open AccessStep-up approach for acute infected necrotizing pancreatitis
Author(s) -
О.І. Dronov,
Inna Kovalska,
Andriy Gorlach,
Tatiana Lubenets
Publication year - 2019
Publication title -
sučasnì medičnì tehnologìï
Language(s) - English
Resource type - Journals
ISSN - 2072-9367
DOI - 10.34287/mmt.2(41).2019.21
Subject(s) - medicine , percutaneous , acute pancreatitis , necrotizing pancreatitis , necrosis , surgery , pancreatitis , prospective cohort study , gastroenterology
Purpose of the study. The role of interventionalmethods of the treatment of acute infected necroticpancreatitis depending on the morphologicalcharacteristics of the disease was determined.Material and methods. In present prospectivecohort study, we included 96 patients with acuteinfected necrotizing pancreatitis. All patients werestratified according to morphologic features. Stepupapproach with following steps of interventionswas applied: percutaneous drainage of infectedfluid collections, increasing of drainagesdiameter and number of it and open or minimallyinvasive necrosectomy. Clinical, laboratory,and instrumental monitoring were the definingindicators for the stopping of the treatment or forthe passing to the next step of the treatment.Results. At the first step 7 of 96 patientswith superficial focal necrosis, a necrosis indexof 2 points and a category D were successfullytreated. Other 89 patients were passed to the second stepof treatment, of which 23 patients with superficialsubtotal necrosis, necrosis index of 2 pointsand category E were successfully treated.Another 66 patients had undergone a third stepof treatment. A multivariate regression analysiswas conducted that allowed to identify predictivefactors of inefficiency of using of percutaneousdrainage interventions (stages I and II) as afinal stage of treatment: transmural subtotal ortotal necrotizing pancreatitis (OR = 1,58; 95%CI 1,03–3,88; p = 0,033); Necrosis index of 4 ormore points (OR = 3.19, 95% CI 1.57–8.37; p = 0,003);heterogeneous peripancreatic fluid collection(OR = 4,15, 95% CI 1,49–5.19; p = 0,001); TheCT-index of severity of acute pancreatitis of 7 or morepoints (OR = 1,89, 95% CI: 1,03–3,43; p = 0,029).Conclusion. Step-up approach showed followingresults: 7,3% patients were treated at the first step,24% – at the second step. Third step of treatmentwas applied in 68,7% of patients, of witch 12,5%was treated with laparoscopic necrosectomy.Predictors of ineffectiveness of ultrasoundguided percutaneous drainage as the finaltreatment method are: necrosis index of 4 or more,heterogeneous paripancreatic fluid collections,subtotal and transmural necrotizing pancreatitis.Keywords: infected pancreatic necrosis, stepupapproach, percutaneous catheter drainage,uncontrolled infection, necrosectomy.