TY - JOUR
T1 - Extrapancreatic necrosis without pancreatic parenchymal necrosis: a separate entity in necrotising pancreatitis?
AU - Bakker, Olaf J.
AU - van Santvoort, Hjalmar
AU - Besselink, Marc G. H.
AU - Boermeester, Marja A.
AU - van Eijck, Casper
AU - Dejong, Kees
AU - van Goor, Harry
AU - Hofker, Sijbrand
AU - Ahmed Ali, Usama
AU - Gooszen, Hein G.
AU - Bollen, Thomas L.
PY - 2013
Y1 - 2013
N2 - In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking. A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis. 315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p <0.001), persistent multiple organ failure (15% vs 36%, p <0.001), infected necrosis (16% vs 47%, p <0.001), intervention (18% vs 57%, p <0.001) and mortality (9% vs 20%, p <0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16). EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar
AB - In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking. A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis. 315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p <0.001), persistent multiple organ failure (15% vs 36%, p <0.001), infected necrosis (16% vs 47%, p <0.001), intervention (18% vs 57%, p <0.001) and mortality (9% vs 20%, p <0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16). EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar
U2 - https://doi.org/10.1136/gutjnl-2012-302870
DO - https://doi.org/10.1136/gutjnl-2012-302870
M3 - Article
C2 - 22773550
SN - 0017-5749
VL - 62
SP - 1475
EP - 1480
JO - Gut
JF - Gut
IS - 10
ER -