Randomized controlled trial on sterile fluid collections management in acute pancreatitis: should they be removed?

Abstract

Prolonged catheter drainage is more efficient for management of recurrent sterile fluid collections in acute pancreatitis than is conservative treatment. Conservative treatment is successful for patients with small fluid collections.

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

“…In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9].…”

“…The aim of this article is to analyse the indications, limits and results of the listed complications treated by percutaneous drainage (PD) which aggravate acute pancreatitis on the basis of the literature. superinfection of the fluid that can be confirmed by fine needle aspiration (FNA) [1, 2,11,19,25,33,37,40,44]. The APFC can be visualized by CT scan or ultrasound examination as well.…”

“…The authors do not recommend surgical treatment in the early phase of the illness because of the high morbidity and mortality rates. With the development of interventional radiology and manipulative laparo-endoscopy there are other possibilities to evacuate these fluid collections without operation [1, 6,11,14,21,25,35,40,44]. For the treatment of sterile fluid collection percutaneous puncture and drainage are widely applied.…”

“…There are some who are satisfied with the clearing of the fluid collection with only one or repeated punctures in sterile cases. However, this is succesful only in a few cases and drainage or surgical intervention follows [6,28,40,44]. According to those who are pro drainage in the treatment of sterile acute peripancreatic fluid collections, drainage can be applied effectively [1, 3,4,14,21,25,34,35,40,44].…”

“…Acute compartment syndrome caused by massive acute peripancreatic fliud collection can be treated effectively with PD [9]. In the randomized controlled trial of Zerem et al they commit themselves to drainage treatment [44]. Those who are against drainage treatment claim that it is the treatment itself which causes the dreadful complication, the infection of the fluid.…”