Complications of Percutaneous Drainage in Step-Up Approach for Management of Pancreatic Necrosis: Experience of 10 Years from a Tertiary Care Center

Gupta, Rajesh; Kulkarni, Aditya; Babu, R; Shenvi, Sunil D.; Gupta, Rahul; Sharma, Gopal; Kang, Mandeep; Gorsi, Ujjwal; Rana, Surinder Singh

doi:10.1007/s11605-019-04470-z

Cited by 15 publications

(10 citation statements)

References 32 publications

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“…To this end, a "step-up" approach has gradually become the gold standard treatment for IPN (176)(177)(178). Two 10-year follow-up studies have reported on the benefits of a step-up approach relative to open necrosectomy, without an increased risk of mortality, reintervention, and long-term complications (179,180). The step-up approach uses PCD or endoscopic necrosectomy as the initial treatment with the purpose of alleviating the systematic inflammatory response of IPN (181,182).…”

Section: Infected Acute Necrotic Collection and Walled-off Necrosismentioning

confidence: 99%

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

Zheng

Ding

et al. 2021

Ann Transl Med

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Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca 2+ ) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.

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Section: Infected Acute Necrotic Collection and Walled-off Necrosismentioning

confidence: 99%

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

Zheng

Ding

et al. 2021

Ann Transl Med

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“…The incidence of AP-associated gastrointestinal fistulae (GIFs) varies between 4.0% and 41.0% and incidence is higher in patients who undergo open necrosectomies (41.0%-47.0%) which are complex and typically external (3,4,10). The most common location of spontaneous internal fistulae is transverse colon and duodenum (Figures 1-6) (10,11).…”

Section: Epidemiologymentioning

confidence: 99%

“…The major risk factors for internal PF include male sex, alcohol abuse, degree of severity of AP, and infected pancreatic necrosis (IPN) (3)(4)(5)(6). A significant male preponderance has been reported in various PF studies, ranging from 60% to 100% (5,6,10,11,16,17).…”

Section: Risks and Associationsmentioning

confidence: 99%

“…Additional signs of GIFs include vomiting of necrotic, feculent, or purulent material, diarrhea with or without blood, or persistent sepsis (11,12,16). Most GIFs are diagnosed beyond 4-8 weeks after the onset of AP (4)(5)(6)12).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…These complications are specifically a consequence of pancreatic duct (PD) disruption, which is contained by an inflammatory fibrous wall. Chronic pressure and secondary infection can result in decompression in proximate organs creating a spontaneous pancreatic fistula (PF) (3)(4)(5)(6)(7). A fistula is defined as an abnormal communication between 2 epithelial surfaces (8).…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Internal Pancreatic Fistulae Complicating Acute Pancreatitis

et al. 2021

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Spontaneous pancreatic fistula (PF) is a rare but challenging complication of acute pancreatitis (AP). The fistulae could be internal (draining into another viscera or cavity, e.g., pancreaticocolonic, gastric, duodenal, jejunal, ileal, pleural, or bronchial) or external (draining to skin, i.e., pancreaticocutaneous). Internal fistulae constitute the majority of PF and will be discussed in this review. Male sex, alcohol abuse, severe AP, and infected necrosis are the major risk factors for development of internal PF. A high index of suspicion is required to diagnose PF. Broad availability of computed tomography makes it the initial test of choice. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography have higher sensitivity compared with computed tomography scan and also allow for assessment of pancreatic duct for leak or disconnection, which affects treatment approaches. Certain complications of PF including hemorrhage and sepsis could be life-threatening and require urgent intervention. In nonurgent/chronic cases, management of internal PF involves control of sepsis, which requires effective drainage of any residual pancreatic collection/necrosis, sometimes by enlarging the fistula. Decreasing fistula output with somatostatin analogs (in pancreaticopleural fistula) and decreasing intraductal pressure with endoscopic retrograde cholangiopancreatography or endoscopic ultrasound/interventional radiology–guided interventions or surgery are commonly used strategies for management of PF. More than 60% of the internal PF close with medical and nonsurgical interventions. Colonic fistula, medical refractory-PF, or PF associated with disconnected pancreatic duct can require surgical intervention including bowel resection or distal pancreatectomy. In conclusion, AP-induced spontaneous internal PF is a complex complication requiring multidisciplinary care for successful management.

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A Case Series of Late Gastrointestinal Fistulization in 16 Patients with Walled-Off Necrosis

et al. 2021

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Complications of Percutaneous Drainage in Step-Up Approach for Management of Pancreatic Necrosis: Experience of 10 Years from a Tertiary Care Center

Cited by 15 publications

References 32 publications

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

Spontaneous Internal Pancreatic Fistulae Complicating Acute Pancreatitis

A Case Series of Late Gastrointestinal Fistulization in 16 Patients with Walled-Off Necrosis

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