PMID- 28196022
OWN - NLM
STAT- MEDLINE
DCOM- 20180306
LR  - 20180625
IS  - 1536-4828 (Electronic)
IS  - 0885-3177 (Linking)
VI  - 46
IP  - 4
DP  - 2017 Apr
TI  - Proactive Versus Standard Percutaneous Catheter Drainage for Infected Necrotizing 
      Pancreatitis.
PG  - 518-523
LID - 10.1097/MPA.0000000000000785 [doi]
AB  - OBJECTIVES: Percutaneous catheter drainage (PCD) is often the first invasive 
      treatment step for infected necrotizing pancreatitis. A proactive PCD strategy, 
      including frequent and early drain revising and upsizing, may reduce the need for 
      surgical necrosectomy and could improve outcomes, but data are lacking. METHODS: 
      Necrotizing pancreatitis patients were identified from in-hospital databases 
      (2004-2014). Patients with primary PCD for infected necrotizing pancreatitis were 
      included. Outcomes of patients from 1 center using a proactive PCD strategy were 
      compared with 3 standard strategy centers. RESULTS: In total, 369 (25.9%) of 1427 
      patients received a diagnosis of necrotizing pancreatitis, and 117 (31.7%) of 369 
      patients underwent primary PCD for infected necrosis: 42 in the proactive group 
      versus 75 in the standard group. Patients in the proactive group had more 
      drain-related procedures (median, 3; interquartile range [IQR], 2-4; versus 2; 
      IQR, 1-2; P < 0.001) and larger final drain sizes (median, 16F; IQR, 14F-20F; 
      versus 14F; IQR, 12F-14F; P < 0.001). Fewer patients underwent additional 
      necrosectomy in the proactive group, 12 (28.6%) versus 39 (52.0%) (adjusted odds 
      ratio, 0.349; 95% confidence interval, 0.137-0.889; P = 0.027), with similar 
      hospital stay and mortality. CONCLUSIONS: A proactive PCD strategy is associated 
      with reduced need for necrosectomy in infected necrotizing pancreatitis, compared 
      with standard PCD, with similar clinical outcomes.
FAU - van Grinsven, Janneke
AU  - van Grinsven J
AD  - From the *Department of Surgery, Academic Medical Center, University of 
      Amsterdam, Amsterdam; daggerDepartment of Surgery, St Antonius Hospital, Nieuwegein; 
      double daggerDepartment of Surgery, University Medical Center Groningen, University of 
      Groningen, Groningen;  section signDepartment of Radiology, Academic Medical Center, 
      University of Amsterdam, Amsterdam;  parallelDepartment of Surgery, Erasmus Medical 
      Center, Erasmus University Rotterdam, Rotterdam; and  paragraph signDepartment of 
      Gastroenterology and Hepatology, Academic Medical Center, University of 
      Amsterdam, Amsterdam, the Netherlands.
FAU - Timmerman, Pieter
AU  - Timmerman P
FAU - van Lienden, Krijn P
AU  - van Lienden KP
FAU - Haveman, Jan Willem
AU  - Haveman JW
FAU - Boerma, Djamila
AU  - Boerma D
FAU - van Eijck, Casper H J
AU  - van Eijck CH
FAU - Fockens, Paul
AU  - Fockens P
FAU - van Santvoort, Hjalmar C
AU  - van Santvoort HC
FAU - Boermeester, Marja A
AU  - Boermeester MA
FAU - Besselink, Marc G
AU  - Besselink MG
CN  - Dutch Pancreatitis Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PL  - United States
TA  - Pancreas
JT  - Pancreas
JID - 8608542
SB  - IM
MH  - Adult
MH  - Aged
MH  - Catheters
MH  - Drainage/*methods
MH  - Female
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Pancreatitis, Acute Necrotizing/*therapy
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2017/02/15 06:00
MHDA- 2018/03/07 06:00
CRDT- 2017/02/15 06:00
PHST- 2017/02/15 06:00 [pubmed]
PHST- 2018/03/07 06:00 [medline]
PHST- 2017/02/15 06:00 [entrez]
AID - 10.1097/MPA.0000000000000785 [doi]
PST - ppublish
SO  - Pancreas. 2017 Apr;46(4):518-523. doi: 10.1097/MPA.0000000000000785.