Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

Jong Jin Hyun; Nadav Sahar; Anand Singla; Andrew S. Ross; Shayan S. Irani; S. Ian Gan; Michael C. Larsen; Richard A. Kozarek; Michael Gluck

doi:10.5009/gnl18234

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Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

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Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

Jong Jin Hyun, Nadav Sahar, Anand Singla, Andrew S. Ross, Shayan S. Irani, S. Ian Gan, Michael C. Larsen, Richard A. Kozarek and Michael Gluck

Gut and liver, Vol.13(2), pp.215-222

03/01/2019

DOI: 10.5009/gnl18234

PMCID: PMC6430426

PMID: 30602076

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Abstract

Background/Aims: Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. Methods: We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. Results: Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). Conclusions: This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.

Gastroenterology & Hepatology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy
Creators: Jong Jin Hyun - Virginia Mason Medical Center
Nadav Sahar - Virginia Mason Medical Center
Anand Singla - Northwestern University
Andrew S. Ross - Virginia Mason Medical Center
Shayan S. Irani - Virginia Mason Medical Center
S. Ian Gan - Virginia Mason Medical Center
Michael C. Larsen - Virginia Mason Medical Center
Richard A. Kozarek - Virginia Mason Medical Center
Michael Gluck - Virginia Mason Medical Center
Resource Type: Journal article
Publication Details: Gut and liver, Vol.13(2), pp.215-222
DOI: 10.5009/gnl18234
PMID: 30602076
PMCID: PMC6430426
NLM abbreviation: Gut Liver
ISSN: 1976-2283
eISSN: 2005-1212
Publisher: Editorial Office Gut & Liver
Number of pages: 8
Language: English
Date published: 03/01/2019
Academic Unit: Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9984359911802771

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