Infected pancreatic necrosis—Current trends in management

Shah, Jimil; Fernandez Y Viesca, Michael; Jagodzinski, Robert; Arvanitakis, Marianna

doi:10.1007/s12664-023-01506-w

Cited by 3 publications

(1 citation statement)

References 91 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some important research areas in infected pancreatic necrosis include diagnostic criteria, early vs. delayed role of interventional management, role of adjuncts and necrosectomy in management, dedicated devices for necrosectomy and place of surgery and percutaneous drainage in management. In this issue, Shah et al have reviewed current trends in the management of infected pancreatic necrosis [17]. The authors have done a thorough literature review and have formulated an algorithmic approach to the management of this complex entity, making it a useful resource for readers.…”

Section: Infected Pancreatic Necrosis-current Trends In Managementmentioning

confidence: 99%

Indian Journal of Gastroenterology—May–June 2024 issue highlights

Sundaram

2024

Indian J Gastroenterol

View full text Add to dashboard Cite

Association between hepatic steatosis and lipoprotein(a) levels in non-alcoholic patients: A systematic reviewNon-alcoholic fatty liver disease (NAFLD) is the most common cause for chronic liver disease worldwide with a spectrum of presentations ranging from fatty liver to cirrhosis and its complications. Recently, a change in nomenclature of NAFLD was made to metabolic syndrome-associated steatotic liver disease (MASLD) to ratify the role of metabolic syndrome in the disease process. MASLD is associated with disorders of lipid homeostasis [1]. Lipotoxicity in MASLD is driven largely by the increased free fatty acids (FFA) levels in the liver either due to influx or de novo lipogenesis. Lipoprotein(a) (Lp[a]) is a lipid carrying particle known to be associated with increased risk of heart disease in previous epidemiological studies. Cardiovascular disease is the most common cause for mortality in patients with MASLD. Whether Lp(a) has any role in the pathogenesis of NAFLD remains unclear.Masson et al. [2] in their systematic review have reviewed the correlation of Lp(a) with NAFLD. They included 10 observational studies with over 40,000 patients to assess this correlation with exclusion of studies that evaluated patients with cirrhosis. The studies included in this review yielded conflicting results. In patients with NAFLD, while four studies showed lower Lp(a) as compared to controls, one study showed higher levels of Lp(a). Those with non-alcoholic steatohepatitis (NASH) showed no significant difference as compared to controls. In the study with NAFLD and NASH included, patients with NASH had much higher levels of Lp(a) as compared to NAFLD, possibly suggesting a role in driving inflammation. In studies that used the MAFLD terminology, Lp(a) levels were not significantly different from controls. Given the ambiguity in the results, it is unclear is Lp(a) is driving the cardiovascular morbidity and liver-related inflammation in NAFLD. However, this represents an area for future research.

show abstract

Section: Infected Pancreatic Necrosis-current Trends In Managementmentioning

confidence: 99%

Indian Journal of Gastroenterology—May–June 2024 issue highlights

Sundaram

2024

Indian J Gastroenterol

View full text Add to dashboard Cite

show abstract

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality

Ali,

Inayat,

Jahagirdar

et al. 2024

World J Methodol

View full text Add to dashboard Cite

BACKGROUND Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus. AIM To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States. METHODS A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality. RESULTS A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06). CONCLUSION Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

show abstract

Role of Necrosectomy in Necrotizing Pancreatitis: A Narrative Review

Vaidya,

Shinde,

Nagtode

et al. 2024

Cureus

View full text Add to dashboard Cite

Necrotizing pancreatitis (NP) is a severe complication of acute pancreatitis, characterized by necrosis of pancreatic and peripancreatic tissues, leading to significant morbidity and mortality. The role of necrosectomy, the surgical removal of necrotic tissue, in the management of NP has evolved over the past few decades, moving from early aggressive surgical intervention to a more conservative and stepwise approach. This narrative review explores the historical perspectives, current practices, and future trends in the role of necrosectomy in NP. Early studies favored open surgical debridement; however, high mortality rates associated with early intervention prompted a shift towards minimally invasive techniques, delayed interventions, and the “step-up approach,” combining percutaneous drainage with minimally invasive surgery. We also review the indications for surgery, optimal timing, and various techniques, including video-assisted retroperitoneal debridement and endoscopic transluminal necrosectomy. The review highlights the benefits of these strategies in reducing complications, improving patient outcomes, and minimizing hospital stays. Ongoing research into patient selection, timing, and procedural refinement will continue to shape the role of necrosectomy in NP management. Understanding the evolving role of necrosectomy is crucial for optimizing care and reducing the burden of this life-threatening condition.

show abstract

Infected pancreatic necrosis—Current trends in management

Cited by 3 publications

References 91 publications

Indian Journal of Gastroenterology—May–June 2024 issue highlights

Indian Journal of Gastroenterology—May–June 2024 issue highlights

Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality

Role of Necrosectomy in Necrotizing Pancreatitis: A Narrative Review

Contact Info

Product

Resources

About