Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis

Lariño‐Noia, José; Iglesia‐García, Daniel de la; González-López, Jaime; Díaz-Lopez, Javier; Macias-García, Fernando; Mejuto, Rafael; Quiroga, A; Mauriz, Violeta; Jardí, Andrea; Iglesias‐García, Julio; Domínguez‐Muñoz, J. Enrique

doi:10.1007/s00464-020-07428-4

Cited by 15 publications

(11 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Development of necrosis and its subsequent infection has significant prognostic implications in pancreatitis. The reported incidence of IPN in necrotizing pancreatitis is 40% to 50% 11 . In the present study, we observed that among the symptomatic necrotic collections requiring drainage, 71% of the patients had infected collections.…”

Section: Discussionsupporting

confidence: 57%

“…The reported incidence of IPN in necrotizing pancreatitis is 40% to 50%. 11 In the present study, we observed that among the symptomatic necrotic collections requiring drainage, 71% of the patients had infected collections. This high incidence of infection in our cohort could be largely attributed to our selection criteria, which included symptomatic patients with persisting pain, fever, jaundice, leukocytosis, and worsening or persistent OF.…”

Section: Discussionsupporting

confidence: 47%

“…Similar to the findings in present study, several authors have noted significant association of IPN with higher rates of OF, need for surgery, and length of ICU stay. 11,17 We tried to identify factors, which could predict infection in pancreatic necrosis. Previous studies have reported extent of necrosis 8 and MCTSI 9 as risk factors for IPN.…”

Section: Factors Predicting Infection In Pancreatic Necrosismentioning

confidence: 99%

See 2 more Smart Citations

Splanchnic Vein Thrombosis

Mandal

Rana

Kang³

et al. 2022

Pancreas

View full text Add to dashboard Cite

Objective: Infected pancreatic necrosis (IPN) is associated with poor outcomes. The present study looked at incidence of infection and predictors, if any, in these collections.Methods: This prospective observational study was done between July 2019 and October 2020. Symptomatic patients of acute necrotic collections and walled-off necrosis of pancreas requiring drainage were included. Necrotic fluid and blood were analyzed for growth of organisms.Results: Sixty-two patients were included. The mean age was 36.8 years (standard deviation, 11.5 years). Male-female ratio was 4:1. Alcohol was the most common etiology. Infection was noted in 44 of the 62 patients (70.9%) and bacteremia noted in 23 of the 62 patients (37%). Escherichia coli was the most common organism in necrotic collections and Staphylococcus was the most common organism isolated from blood culture. The patients with Modified Computed Tomography-Severity Index of 8 of higher (P < 0.001) had significant association with IPN but not with bacteremia. However, splanchnic vein thrombosis (P = 0.022) was significantly associated with development of IPN as well as bacteremia on both univariate and multivariate analysis.Conclusions: Escherichia coli and Staphylococcus were the most common organisms grown from necrotic collections and blood respectively. Presence of splanchnic vein thrombosis was a significant factor for development of IPN and bacteremia on univariate as well as multivariate analysis.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionsupporting

confidence: 47%

Section: Factors Predicting Infection In Pancreatic Necrosismentioning

confidence: 99%

See 1 more Smart Citation

Splanchnic Vein Thrombosis

Mandal

Rana

Kang³

et al. 2022

Pancreas

View full text Add to dashboard Cite

show abstract

“… 87 In a study comprising 48 patients with infected pancreatic necrosis, 19 patients responded to systematic antibiotics and did not require any invasive intervention. 88 Endoscopic drainage and local antibiotic instillation were performed in 20 patients. Nine patients improved while a similar number underwent necrosectomy.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

Gupta

Madhusudhan

Padmanabhan

et al. 2022

Indian J Radiol Imaging

View full text Add to dashboard Cite

Acute pancreatitis (AP) is one of the common gastrointestinal conditions presenting as medical emergency. Clinically, the severity of AP ranges from mild to severe. Mild AP has a favorable outcome. Patients with moderately severe and severe AP, on the other hand, require hospitalization and considerable utilization of health care resources. These patients require a multidisciplinary management. Pancreatic fluid collections (PFCs) and arterial bleeding are the most important local complications of pancreatitis. PFCs may require drainage when infected or symptomatic. PFCs are drained endoscopically or percutaneously, based on the timing and the location of collection. Both the techniques are complementary, and many patients may undergo dual modality treatment. Percutaneous catheter drainage (PCD) remains the most extensively utilized method for drainage in patients with AP and necrotic PFCs. Besides being effective as a standalone treatment in a significant proportion of these patients, PCD also provides an access for percutaneous endoscopic necrosectomy and minimally invasive necrosectomy. Endovascular embolization is the mainstay of management of arterial complications in patients with AP and chronic pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the percutaneous management of complications of pancreatitis.

show abstract

“…Imaging has a high diagnostic value for IPN, with characteristic features including the "bubble sign" (i.e., a gas/liquid level) and morphological features of cellulitis observed on CT in the area of necrosis (13,169). Clinical symptoms, such as SIRS and organ dysfunction, can provide auxiliary indicators for diagnosis (5,16,170). Bacterial culture from pancreatic tissue, obtained by percutaneous fine needle aspiration (FNA), may also assist in the diagnosis of IPN (171), although Japanese guidelines recommend against the routine use of FNA, indicating that FNA should be used for patients with suspected fungal infection or an infection that has not been effectively controlled using multiple antibiotics (172).…”

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

View full text Add to dashboard Cite

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.

show abstract

Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis

Cited by 15 publications

References 29 publications

Splanchnic Vein Thrombosis

Splanchnic Vein Thrombosis

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

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

Contact Info

Product

Resources

About