TY - JOUR
T1 - Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study
AU - van Grinsven, Janneke
AU - van Brunschot, Sandra
AU - Bakker, Olaf J.
AU - Bollen, Thomas L.
AU - Boermeester, Marja A.
AU - Bruno, Marco J.
AU - Dejong, Cornelis H.
AU - Dijkgraaf, Marcel G.
AU - van Eijck, Casper H.
AU - Fockens, Paul
AU - van Goor, Harry
AU - Gooszen, Hein G.
AU - Horvath, Karen D.
AU - van Lienden, Krijn P.
AU - van Santvoort, Hjalmar C.
AU - Besselink, Marc G.
AU - AUTHOR GROUP
AU - Abdelhafez, M.
AU - Andersson, R.
AU - Andren-Sandberg, A.
AU - Ashley, S.
AU - van Baal, M.
AU - Baron, T.
AU - Bassi, C.
AU - Bradley, E.
AU - Buchler, M.
AU - Cappendijk, V.
AU - Carter, R.
AU - Charnley, R.
AU - Coelho, D.
AU - Connor, S.
AU - Dellinger, P.
AU - Dervenis, C.
AU - Deviere, J.
AU - Doctor, N.
AU - Dudeja, V.
AU - En-Qiang, M.
AU - Escourrou, J.
AU - Fagenholz, P.
AU - Farkas, G.
AU - Forsmark, C.
AU - Freeman, M.
AU - Freeny, P.
AU - French, J.
AU - Friess, H.
AU - Gardner, T.
AU - Goetzinger, P.
AU - Haveman, J.
AU - Hofker, S.
AU - Imrie, C.
AU - Voermans, R.
PY - 2016
Y1 - 2016
N2 - 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
AB - 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
U2 - https://doi.org/10.1016/j.hpb.2015.07.003
DO - https://doi.org/10.1016/j.hpb.2015.07.003
M3 - Article
C2 - 26776851
SN - 1365-182X
VL - 18
SP - 49
EP - 56
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 1
ER -