Outcomes after implementing a tailored endoscopic step-up approach to walled-off necrosis in acute pancreatitis. Issue 13 (21st October 2014)

• Record Type: Journal Article
• Authors: Bang, J Y; Holt, B A; Hawes, R H; Hasan, M K; Arnoletti, J P; Christein, J D; Wilcox, C M; Varadarajulu, S
• Is Part Of: British journal of surgery. Volume 101:Issue 13(2014)
• Page Start: 1729
• Page End: 1738
• Publication Date: 2014-10-21
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9664
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: The aim of the study was to compare the outcomes of patients with pancreatic or peripancreatic walled-off necrosis by endoscopy using the conventional approach versus an algorithmic approach based on the collection size, location and stepwise response to intervention. Methods: This was an observational before–after study of consecutive patients managed over two time intervals. In the initial period (2004–2009) symptomatic patients with walled-off necrosis underwent conventional single transmural drainage with placement of two stents and a nasocystic catheter, followed by direct endoscopic necrosectomy, if required. In the later period (2010–2013) an algorithmic approach was adopted based on size and extent of the walled-off necrosis and stepwise response to intervention. The main outcome was treatment success, defined as a reduction in walled-off necrosis size to 2 cm or less on CT after 8 weeks. Results: Forty-seven patients were treated in the first interval and 53 in the second. There was no difference in patient demographics, clinical or walled-off necrosis characteristics and laboratory parameters between the groups, apart from a higher proportion of women and Caucasians in the later period. The treatment success rate was higher for the algorithmic approach compared with conventional treatment (91 versus 60 per cent respectively; P < 0·001). On multivariable logistic regression, management based on the algorithm was the only predictor of treatment success (odds ratio 6·51, 95 per cent c.i. 2·19 to 19·37; P = 0·001). Conclusion: An algorithmic approach to pancreatic and peripancreatic walled-off necrosis, based on the collection size, location and stepwise response to intervention, resulted in an improved rate of treatment success compared with conventional endoscopic management. Abstract : Tailored approach improves outcomes