Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis

an international expert survey and case vignette study

Dutch Pancreatitis Study Group, Dutch Pancreatitis Study Group, M. Sarr

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background 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. Methods 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. 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. 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). 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.

Original languageEnglish (US)
Pages (from-to)49-56
Number of pages8
JournalHPB
Volume18
Issue number1
DOIs
StatePublished - 2016

Fingerprint

Pancreatitis
Necrosis
Fine Needle Biopsy
Drainage
Catheters
Surveys and Questionnaires
Anti-Bacterial Agents
Therapeutics

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis : an international expert survey and case vignette study. / Dutch Pancreatitis Study Group; Dutch Pancreatitis Study Group; Sarr, M.

In: HPB, Vol. 18, No. 1, 2016, p. 49-56.

Research output: Contribution to journalArticle

Dutch Pancreatitis Study Group ; Dutch Pancreatitis Study Group ; Sarr, M. / Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis : an international expert survey and case vignette study. In: HPB. 2016 ; Vol. 18, No. 1. pp. 49-56.
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abstract = "Background 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. Methods 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. 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. 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). 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.",
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AU - Dutch Pancreatitis Study Group

AU - Dutch Pancreatitis Study Group

AU - van Grinsven, Janneke

AU - van Brunschot, Sandra

AU - Fockens, Paul

AU - van Grinsven, Janneke

AU - Bakker, Olaf J.

AU - van Santvoort, Hjalmar C.

AU - Bollen, Thomas L.

AU - Boermeester, Marja A.

AU - van Santvoort, Hjalmar C.

AU - Besselink, Marc G.

AU - Bruno, Marco J.

AU - Dejong, Cornelis H.

AU - Dijkgraaf, Marcel G.

AU - van Eijck, Casper H.

AU - van Goor, Harry

AU - Gooszen, Hein G.

AU - Horvath, Karen D.

AU - van Lienden, Krijn P.

AU - Abdelhafez, M.

AU - Andersson, R.

AU - Andren-Sandberg, A.

AU - Ashley, S.

AU - van Baal, M.

AU - Baron, T.

AU - Bassi, C.

AU - Bradley, E.

AU - Buchler, M.

AU - Cappendijk, V.

AU - Carter, R.

AU - Charnley, R.

AU - Coelho, D.

AU - Connor, S.

AU - Dellinger, P.

AU - Dervenis, C.

AU - Deviere, J.

AU - Doctor, N.

AU - Dudeja, V.

AU - En-qiang, M.

AU - Escourrou, J.

AU - Fagenholz, P.

AU - Farkas, G.

AU - Forsmark, C.

AU - Freeman, M.

AU - Freeny, P.

AU - French, J.

AU - Sarr, M.

AU - Gardner, T.

AU - Goetzinger, P.

AU - Singh, Vijay Prem

AU - Vege, Santhi Swaroop

PY - 2016

Y1 - 2016

N2 - Background 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. Methods 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. 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. 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). 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.

AB - Background 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. Methods 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. 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. 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). 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.

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