Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?

Gasparoto, Rafaela Cristina Goebel Winter; Racy, Marcelo de Castro Jorge; Campos, Tércio De

doi:10.6092/1590-8577/2958

Cited by 13 publications

(13 citation statements)

References 38 publications

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“…Quality of life scores obtained from questionnaires of patients after an episode of SAP were compared with age-matched healthy controls in 10 studies ( Table 3 ). Six studies demonstrated a statistically significant reduction in at least one domain of QoL compared with control 5 , 18 , 20 , 22 , 25 , 26 . Five studies showed no difference in the QoL of SAP patients when compared with control after at least 19 months of follow-up 6 , 13 , 17 , 21 , 23 .…”

Section: Resultsmentioning

confidence: 98%

“…Eight studies used the SF-36 as a QoL tool, with comparison to age-matched controls, and provided a detailed analysis of the results for each domain of the questionnaire 5 , 13 , 18 , 21 , 22 , 25 , 26 , 32 ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…The sequelae of SAP, including pancreatic necrosis, pseudocyst, superimposed infection, and abscess, impact short-term as well as long-term patient outcomes 7 , 8 . Recent research on the pathophysiology of pancreatitis suggests that unlike in mild AP, the pancreas gland does not fully recover after an episode of SAP 5 , 9 as it can potentially change pancreatic morphology, affecting its function to an extent which can impact patient quality of life (QoL) 10 .…”

Section: Introductionmentioning

confidence: 99%

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Quality of life after severe acute pancreatitis: systematic review

Giorga,

Hughes,

Parker

et al. 2023

BJS Open

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Background Severe acute pancreatitis, the most severe form of acute pancreatitis, can alter pancreatic morphology, physiology, and function resulting in long-term morbidity, even after a single episode. This review assesses long-term outcomes and quality of life of severe acute pancreatitis. Methods A comprehensive literature review was conducted across MEDLINE, Embase, Scopus, and PubMed electronic databases on 18 January 2021 and updated on 26 April 2022 to ensure no new literature had been omitted. All studies were prospective or retrospective, included adult patients (>18 years) presenting with acute pancreatitis for whom data on long-term outcomes specifically after severe acute pancreatitis were reported. Quantitative and qualitative data extraction and synthesis were carried out and no meta-analysis was performed. Outcome measures included aetiology and mortality of severe acute pancreatitis, length of stay, endocrine and exocrine pancreatic insufficiency, chronic symptoms, and quality of life compared with healthy controls as assessed by validated questionnaires. Results Fourteen retrospective cohort studies were included, for a total of 779 patients, using quality of life questionnaires. The most common aetiology of severe acute pancreatitis was biliary (36 per cent) followed by alcoholic (29 per cent). Mortality rate ranged from 5 to 35 per cent and length of stay ranged from 2 to 367 days. Quality of life was somewhat lower in patients with exocrine insufficiency, but unaffected by endocrine insufficiency or chronic symptoms. Quality of life was more likely to be reduced in the first 4 years but normalize thereafter and was more likely to be negatively affected where alcohol was the aetiology. In four studies, the relationship between disease severity and lower quality of life was investigated, and a significant correlation was found. Conclusion The review shows how a single episode of severe acute pancreatitis can have a variable effect on long-term quality of life, which is different to previous studies showing a strong reduction in quality of life. This could indicate that in current times treatment modalities are more effective.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of life after severe acute pancreatitis: systematic review

Giorga,

Hughes,

Parker

et al. 2023

BJS Open

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“…According to the research results, approximately 1/3 rd of patients had pancreatic endocrine insufficiency, and about 40% of patients had diabetes or pre-diabetes after AP, which was mainly caused by irreversible pancreatic damage[ 16 , 17 ]. Winter Gasparoto et al [ 18 ] followed-up AP patients for an average of 2.9 years and found that 43.7% of the patients developed pre-diabetes and 31.3% developed diabetes after AP[ 18 ]. A large study in Taiwan that followed 2966 patients with AP and 11864 healthy controls over a long period found that the incidence of diabetes in the first 3 mo after the onset of AP was 60.8/1000 per year compared to 8.0/1000 per year in the control group[ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of safety, efficacy, and long-term follow-up between “one-step” and “step-up” approaches for infected pancreatic necrosis

Zheng¹,

Lu²,

Ding³

et al. 2021

WJGS

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BACKGROUND Although the “Step-up” strategy is the primary surgical treatment for infected pancreatic necrosis, it is not suitable for all such patients. The “One-step” strategy represents a novel treatment, but the safety, efficacy, and long-term follow-up have not yet been compared between these two approaches. AIM To compare the safety, efficacy, and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment. METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent “One-step” or “Step-up” necrosectomy at Xuan Wu Hospital, Capital Medical University, from May 2014 to December 2020. The primary outcome was the composite endpoint of severe complications or death. Patients were followed up every 6 mo after discharge until death or June 30, 2021. Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0, and statistical significance was set at P < 0.05. RESULTS One-hundred-and-fifty-eight patients were enrolled, of whom 61 patients underwent “One-step” necrosectomy and 97 patients underwent “Step-up” necrosectomy. During the long-term follow-up period, 40 patients in the “One-step” group and 63 patients in the “Step-up” group survived. The time from disease onset to hospital admission (53.69 ± 38.14 vs 32.20 ± 20.75, P < 0.001) and to initial surgical treatment was longer in the “Step-up” than in the “One-step” group (54.38 ± 10.46 vs 76.58 ± 17.03, P < 0.001). Patients who underwent “Step-up” necrosectomy had a longer hospitalization duration (65.41 ± 28.14 vs 52.76 ± 24.71, P = 0.02), and more interventions (4.26 ± 1.71 vs 3.18 ± 1.39, P < 0.001). Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group. Although the incisional hernia incidence was higher in the “One-step” group, no significant difference was found in the composite outcomes of severe complications or death, new-onset organ failure, postoperative complications, inflammatory indicators, long-term complications, quality of life, and medical costs between the groups ( P > 0.05). CONCLUSION Compared with the “Step-up” approach, the “One-step” approach is a safe and effective treatment method with better long-term quality of life and prognosis. It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.

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“…This observation was confirmed by Bavare et al [ 77 ], who stated that, following necrotic pancreatitis, pancreatic exocrine or endocrine disorders were observed in more than half of patients who had undergone a pancreatic necrosectomy. Tsiotos et al [ 78 ] and Gasparoto et al [ 79 ] also found that necrotizing pancreatitis had a significant effect on the disturbance of exocrine and endocrine pancreatic function in half of the patients in their studies. In these cases, pancreatic morphological changes were common (62.5%), and more so in patients with extensive necrosis.…”

Section: Clinical Severity Of Acute Pancreatitis and The Development ...mentioning

confidence: 96%

The Cause and Effect Relationship of Diabetes after Acute Pancreatitis

2023

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Acute pancreatitis (AP) is an acute inflammation of the pancreas associated with high morbidity and mortality. Endocrine pancreatic insufficiency secondary to AP has drawn increasing attention in recent years. The aim of this paper is to analyze the available clinical and experimental literature to determine the cause and effect relationship of diabetes type 3c (T3cDM; pancreatogenic diabetes) after acute pancreatitis. The clinico-pathological features and management challenges of pancreatogenic diabetes overlap with other secondary causes of diabetes. A complex pathogenesis involving pancreatic exocrine insufficiency, dysfunction of insulin secretion, and insulin resistance is likely the cause of T3cDM after AP. To obtain an improved understanding of the pathophysiology of diabetes after AP, more research is now needed to understand the risk of complications related to the pancreas and diabetes in these patients.

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Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?

Cited by 13 publications

References 38 publications

Quality of life after severe acute pancreatitis: systematic review

Quality of life after severe acute pancreatitis: systematic review

Comparison of safety, efficacy, and long-term follow-up between “one-step” and “step-up” approaches for infected pancreatic necrosis

The Cause and Effect Relationship of Diabetes after Acute Pancreatitis

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