Logo image
Back
Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study
Journal article   Open access   Peer reviewed

Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study

Janneke van Grinsven, Sandra van Brunschot, Olaf J Bakker, Thomas L Bollen, Marja A Boermeester, Marco J Bruno, Cornelis H Dejong, Marcel G Dijkgraaf, Casper H van Eijck, Paul Fockens, …
HPB (Oxford, England), Vol.18(1), pp.49-56
01/01/2016
DOI: 10.1016/j.hpb.2015.07.003
PMID: 26776851
url
https://doi.org/10.1016/j.hpb.2015.07.003View
Published (Version of record) Open Access

Abstract

The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists. An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy. The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive). The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.
 Anti-Bacterial Agents - administration & dosage Biopsy, Fine-Needle Consensus Drainage - adverse effects Drainage - trends Drug Administration Schedule Health Care Surveys Humans International Cooperation Pancreatectomy - adverse effects Pancreatectomy - trends Pancreatitis, Acute Necrotizing - diagnosis Pancreatitis, Acute Necrotizing - microbiology Pancreatitis, Acute Necrotizing - therapy Practice Patterns, Physicians' - trends Predictive Value of Tests Risk Factors Surveys and Questionnaires Time Factors Time-to-Treatment - trends

Details

Metrics

1 Record Views
62 Times Cited - Web of Science
Logo image