Interventionen bei der Pankreatitis

Dubasz, K; Misbahuddin, Mir; Graeb, Christian; Radeleff, Boris

doi:10.1007/s00117-021-00856-w

Cited by 4 publications

(5 citation statements)

References 39 publications

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“…At the same time, treatment courses of severe pancreatitis can be extremely protracted and often require specific gastroenterological competencies and close interdisciplinary collaboration with interventional radiological and surgical disciplines in the context of complication management [26]. This relates, for example, to the options of endoscopic necrosectomy via lumen-apposing metal stents (LAMS), radiological drainage, and surgical video-assisted necrosectomies [27,28]. Our study observed a total hospital mortality rate for AP of 2.85 %, which is in good agreement with previous studies from Germany [1,4] and other western countries [29,30,31].…”

Section: Discussionmentioning

confidence: 99%

Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

et al. 2021

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Background Acute pancreatitis (AP) represents a common gastrointestinal disorder. Complicated disease courses in particular still represent a major clinical challenge and are associated with high mortality. Evaluation of existing data sets and their careful interpretation can support a rational discussion to optimize outcomes of this common gastrointestinal disease. Methods We used standardized hospital discharge data provided by the Federal Statistical Office of Germany to evaluate hospital mortality and current developments of AP in Germany between 2008 and 2017. Results In this analysis, 516,618 hospitalized AP cases were included. Main disease etiologies featured biliary (29.9%) and alcoholic (22.7%) AP. The annual frequency of AP increased from 48,858 (2008) to 52,611 (2017), mainly due to a rising incidence of biliary AP. Average hospital mortality was 2.85% and significantly improved over time. While uncomplicated AP had low hospital mortality (1.38%), the presence of organ complications was associated with a mortality of 12.34%. The necessity of mechanical ventilation dramatically increased hospital mortality to 44.06%. Hospital mortality was significantly higher in female patients (3.31%) than males (2.55%) and showed a stepwise increase with patient age. We further identified type 2 diabetes mellitus and obesity as factors associated with increased hospital mortality. Hospital mortality was lowest among patients treated at departments specializing in gastroenterology. Finally, high case volume centers (defined as >98 annual AP cases) had the lowest hospital mortality for patients with complicated courses of AP. Conclusion With over 50,000 annual hospitalization cases, AP is one of the most important inpatient treatment indications in gastroenterology in Germany. Overall, AP mortality has improved in recent years, presumably due to improved interdisciplinary treatment concepts. In this study, we identified important clinical and epidemiological risk factors for an unfavorable course, which could help to improve risk prediction and triaging, and thus the management of AP.

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Section: Discussionmentioning

confidence: 99%

Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

et al. 2021

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“…This is because the earlier drainage is performed, the more effectively toxic and harmful substances can be cleared, thereby reducing the inflammatory response, slowing down, or even halting the progression of SAP[ 28 - 30 ]. Therefore, compared to patients who undergo drainage later, those who receive early drainage have a lower progression rate, indicating that their disease is less likely to worsen, leading to better clinical outcomes[ 31 - 33 ].…”

Section: Discussionmentioning

confidence: 99%

Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intra-abdominal fluid accumulation

Chen,

et al. 2024

World J Gastrointest Surg

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BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter placement and drainage. AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumulation. METHODS Using a retrospective approach, 184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement: group A (catheter placement within 2 d of symptom onset, n = 89), group B (catheter placement between days 3 and 5 after symptom onset, n = 55), and group C (catheter placement between days 6 and 7 after symptom onset, n = 40). The differences in progression rate, mortality rate, and the number of cases with organ dysfunction were compared among the three groups. RESULTS The progression rate of group A was significantly lower than those in groups B and groups C (2.25% vs 21.82% and 32.50%, P < 0.05). Further, the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C (41.57% vs 70.91% and 75.00%, P < 0.05). The mortality rates in group A, group B, and group C were similar (P > 0.05). At postoperative day 3, the levels of C-reactive protein (55.41 ± 19.32 mg/L vs 82.25 ± 20.41 mg/L and 88.65 ± 19.14 mg/L, P < 0.05), procalcitonin (1.36 ± 0.51 ng/mL vs 3.20 ± 0.97 ng/mL and 3.41 ± 0.98 ng/mL, P < 0.05), tumor necrosis factor-alpha (15.12 ± 6.63 pg/L vs 22.26 ± 9.96 pg/L and 23.39 ± 9.12 pg/L, P < 0.05), interleukin-6 (332.14 ± 90.16 ng/L vs 412.20 ± 88.50 ng/L and 420.08 ± 87.65ng/L, P < 0.05), interleukin-8 (415.54 ± 68.43 ng/L vs 505.80 ± 66.90 ng/L and 510.43 ± 68.23ng/L, P < 0.05) and serum amyloid A (270.06 ± 78.49 mg/L vs 344.41 ± 81.96 mg/L and 350.60 ± 80.42 mg/L, P < 0.05) were significantly lower in group A compared to those in groups B and group C. The length of hospital stay in group A was significantly lower than those in groups B and group C (24.50 ± 4.16 d vs 35.54 ± 6.62 d and 38.89 ± 7.10 d, P < 0.05). The hospitalization expenses in group A were also significantly lower than those in groups B and groups C [2.70 (1.20, 3.55) ten-thousand-yuan vs 5.50 (2.98, 7.12) ten-thousand-yuan and 6.00 (3.10, 8.05) ten-thousand-yuan, P < 0.05). The incidence of complications in group A was markedly lower than that in group C (5.62% vs 25.00%, P < 0.05), and similar to group B (P > 0.05). CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.

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“…Pseudoaneurysms of the pancreatic arteries are rare in the literature, either as case reports or review of these reports. [2][3][4][5][6][7] Chronic pancreatitis is a complex; multi etiological disease with various clinical presentations can be by different factors alcohol, smoking and genetic. 8 The alcoholic etiology of chronic pancreatitis is the most common, the etiology being observed in the case report.…”

Section: Discussionmentioning

confidence: 99%

“…3 Arterial complications affect 1-10% of all patients with pancreatitis, most of whom are ruptured pseudoaneurysms, which represent the most dangerous hemorrhagic complication of pancreatitis and can be treated with a high technical success rate through embolization and/or use of endovascular stent. 4 The pooled incidence rates of pseudoaneurysms in acute and chronic pancreatitis were 0.05% and 0.03%. The most common site of pseudoaneurysm was the splenic artery 37.7%.…”

Section: Introductionmentioning

confidence: 97%

Endovascular treatment of ruptured dorsal pancreatic artery pseudoaneurysm: case report

Maria Pereira de Godoy,

Souza de Lima,

Mariana de Morais Castellari

et al. 2023

MOJBM

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The objective of the present study is to report the technical success of the endovascular procedure in the treatment of pseudoaneurysm of the dorsal pancreatic artery. A 60-year-old white male patient came to the emergency room, complaining of the appearance of an ulcerated wound in the distal third of the left lower limb for 20 days. Alcoholic, smoker and previous diagnosis of chronic pancreatitis. On physical examination, upon admission, the abdomen was normotensive, painless on palpation and without masses or visceromegaly. During the investigation of this ulcer and 12 hours after admission, the patient developed diffuse abdominal pain and distension, more intense in the upper abdomen and associated with peritonitis. A computed tomography scan of the upper abdomen and pelvis was performed, which showed a pseudoaneurysm of the dorsal artery of the pancreas with frank extravasation of contrast into the abdominal cavity, in addition to a moderate amount of free blood around the liver. He underwent endovascular embolization treatment, in which he was selectively catheterized splenic artery and dorsal pancreas with therapeutic success.

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Interventionen bei der Pankreatitis

Cited by 4 publications

References 39 publications

Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

Current epidemiological trends and in-hospital mortality of acute pancreatitis in Germany: a systematic analysis of standardized hospital discharge data between 2008 and 2017

Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intra-abdominal fluid accumulation

Endovascular treatment of ruptured dorsal pancreatic artery pseudoaneurysm: case report

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