Article ; Online: Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis.
2020 Volume 35, Issue 2, Page(s) 644–651
Abstract: Background: Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of ... ...
| Abstract | Background: Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. Methods: Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. Results: 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4 weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53% CONCLUSIONS: Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics. |
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| MeSH term(s) | Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Drainage/methods ; Endoscopy, Digestive System/methods ; Female ; Humans ; Intraabdominal Infections/mortality ; Intraabdominal Infections/surgery ; Intraabdominal Infections/therapy ; Male ; Middle Aged ; Pancreatectomy ; Pancreatitis, Acute Necrotizing/mortality ; Pancreatitis, Acute Necrotizing/surgery ; Pancreatitis, Acute Necrotizing/therapy ; Retrospective Studies ; Stents ; Treatment Outcome ; Ultrasonography, Interventional/methods | |||||
| Chemical Substances | Anti-Bacterial Agents | |||||
| Language | English | |||||
| Publishing date | 2020-02-19 | |||||
| Publishing country | Germany | |||||
| Document type | Journal Article | |||||
| ZDB-ID | 639039-0 | |||||
| ISSN | 1432-2218 ; 0930-2794 | |||||
| ISSN (online) | 1432-2218 | |||||
| ISSN | 0930-2794 | |||||
| DOI | 10.1007/s00464-020-07428-4 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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