Sa1358 Endoscopic Ultrasound Follow up Study of Fluid Collections in Acute Necrotizing Pancreatitis: Are They Pseudocysts, Walled off Pancreatic Necrosis or Need a New Name?

Rana, Surinder Singh; Bhasin, Deepak K.; Reddy, Yalaka Rami; Chalapathi, Rao; Sharma, Ravi; Gupta, Rajesh

doi:10.1016/s0016-5085(13)60963-4

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It enables targeted therapeutic interventions tailored to the specific aetiology, potentially preventing recurrent episodes and disease progression. EUS aids the decision of the appropriate treatment, such as sphincterotomy, stone extraction, or stent placement, and allows addressing biliary pathologies [50,[76][77][78][79]. Additionally, EUS facilitates early detection of neoplastic lesions, leading to timely diagnosis and appropriate treatment, ultimately improving patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review

Cammarata,

Rovati,

Fontana

et al. 2023

Diagnostics

View full text Add to dashboard Cite

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP’s enigma and advancing diagnostic and therapeutic strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review

Cammarata,

Rovati,

Fontana

et al. 2023

Diagnostics

View full text Add to dashboard Cite

show abstract

“…However, there is scant data to support these recommendations. The available studies are either retrospective with small sample size and short follow up or have heterogeneous study population [ 7 - 10 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis

Kumar¹,

Sonika²,

Sachdeva³

et al. 2023

Cureus

View full text Add to dashboard Cite

Background and objectivesStudies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methodsIn this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. ResultsOf the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most common etiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) and CTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. ConclusionAround one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.

show abstract

“…It is usually recommended to postpone the PCD or necrosectomy until the necrosis has walled off and become more liquefied, which takes about 4 weeks. 4,9,10 Patients with infected pancreatic necrosis (IPN) who present in the second or third week of illness, on the other hand, present a therapeutic challenge because the necrotic collection is unorganized. Various treatment approaches have been reported in this situation, such as delaying intervention by providing antibiotics and supportive care, or immediate PCD drainage followed by minimally invasive surgical necrosectomy, sinus tract necrosectomy, or percutaneous endoscopic necrosectomy (PEN).…”

mentioning

confidence: 99%

“…It is usually recommended to postpone the PCD or necrosectomy until the necrosis has walled off and become more liquefied, which takes about 4 weeks 4,9,10 …”

mentioning

confidence: 99%

A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy

Mangiafico,

Bertani,

Pigò

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Acute pancreatitis in 10% to 20% of cases can be associated with necrosis of the pancreatic gland, peripancreatic tissue, or both. We report a case series of a new endoscopic approach to treat infected pancreatic necrosis (IPN). Patients and Methods: Consecutive patients with IPN, extending from the perigastric area up to the paracolic gutters or into the pelvis, were prospectively studied from January 2017 to June 2022. The treatment protocol was radiologic percutaneous drainage as the first step, followed by fully covered metal stent placement (FC-SEMS) in the track of the catheter. Percutaneous endoscopic necrosectomy (PEN) was performed 2 to 4 days later using a flexible endoscope through the percutaneous tract. About 2 to 4 weeks later, when a matured sac was visible, EUS-guided endoscopic transluminal drainage (ETD) with lumen-apposing metal stents (LAMS) was performed. Control of sepsis with resolution of collection(s) was the primary outcome measure. Results: We included 18 patients, males in 50% of cases with age 60±12 years old. Most frequent cause of pancreatitis was biliary (7 cases) followed by alcoholic in 6 cases; in 3 cases pancreatitis was caused by hyperlipemia and in 2 cases was idiopathic. Mean size of WON was 18±2 cm. For PEN, SEMSs used were esophageal FC-SEMS. LAMS used for ETD were Hot Axios, Hot Spaxus and Nagistent. Mean time of endoscopic intervention for PEN and ETD was 18±3 and 37±4 days, respectively. In 5 cases adverse events occurred: 3 cases of overinflations resolved with introduction of Verres needles in abdomen. In 2 cases postprocedural GI bleeding required endoscopic intervention. In all cases control of sepsis was reached together with resolution of collections. No cases of deaths were observed. Conclusions: Step-up percutaneous and transluminal endoscopic necrosectomy therapy is an effective strategy for large-size IPN with combined central and peripheral necrosis.

show abstract

Sa1358 Endoscopic Ultrasound Follow up Study of Fluid Collections in Acute Necrotizing Pancreatitis: Are They Pseudocysts, Walled off Pancreatic Necrosis or Need a New Name?

Cited by 3 publications

References 0 publications

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review

Endoscopic Ultrasound to Identify the Actual Cause of Idiopathic Acute Pancreatitis: A Systematic Review

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis

A New Step-Up Dual Endoscopic Approach for Large-Size Infected Pancreatic Necrosis: Percutaneous Endoscopic Necrosectomy Followed by Transluminal Endoscopic Drainage/Necrosectomy

Contact Info

Product

Resources

About