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

2015; Elsevier BV; Volume: 18; Issue: 1 Linguagem: Inglês

10.1016/j.hpb.2015.07.003

1477-2574

Janneke van Grinsven, Sandra van Brunschot, Olaf J. Bakker, Thomas L. Bollen, Marja A. Boermeester, Marco J. Bruno, Cornelis H.C. Dejong, Marcel G. W. Dijkgraaf, Casper H.J. van Eijck, Paul Fockens, Harry van Goor, Hein G. Gooszen, Karen D. Horvath, Krijn P. van Lienden, Hjalmar C. van Santvoort, Marc G. Besselink, Mohamed Abdelhafez, Roland Andersson, A. Andren-Sandberg, Stanley W. Ashley, Marchien van Baal, Todd H. Baron, Claudio Bassi, E. L. Bradley, Markus W. Büchler, Vincent C. Cappendijk, R. Carter, Richard Charnley, Davi Neves Coelho, Saxon Connor, Patchen Dellinger, Christos Dervenis, J. Devière, N. Doctor, Vikas Dudeja, Enqiang Mao, J Escourrou, Peter J. Fagenholz, Gyula Farkas, Christopher E. Forsmark, Martin L. Freeman, Patrick C. Freeny, Jeremy French, Helmut Frieß, Timothy B. Gardner, P. Goetzinger, J. Haveman, S. Hofker, C W Imrie, Shuji Isaji, R. Isenmann, E. Klar, Johan S. Laméris, Markus M. Lerch, Patrick Lévy, Keith D. Lillemoe, Matthias Löhr, Julia Mayerle, Toshihiko Mayumi, Anubhav Mittal, J. Moessner, Desiree E. Morgan, Koenraad J. Mortelé, William H. Nealon, John P. Neoptolemos, Vincent B. Nieuwenhuijs, Isto Nordback, Attila Oláh, Kofi Oppong, Robert Padbury, George Papachristou, Rowan W. Parks, Jan‐Werner Poley, Dejan Radenković, Michael Raraty, Beate Rau, Vinciane Rebours, Susanne Rische, Michael Rünzi, Nisha I. Sainani, M. G. Sarr, S. Schaapherder, Stefan Seewald, H Seifert, Tooru Shimosegawa, Stuart G. Silverman, Vijay Singh, Ajith K. Siriwardena, William M. Steinberg, R. Sutton, K Takeda, R. Timmer, Santhi Swaroop Vege, Rogier P. Voermans, Jan J. De Waele, Chun‐Hua Wang, Andrew L. Warshaw, Jens Werner, Bas L. Weusten, David C. Whitcomb, Jai Dev Wig, John A. Windsor, Nicholas J. Zyromski,

Pancreatic and Hepatic Oncology Research

BackgroundThe 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.MethodsAn 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.ResultsThe 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).DiscussionThe 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.