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. 2015 Oct 17.
doi: 10.1111/hpb.12491. Online ahead of print.

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

Janneke van Grinsven  1   2 , Sandra van Brunschot  1 , Olaf J Bakker  3 , Thomas L Bollen  4 , Marja A Boermeester  5 , Marco J Bruno  6 , Cornelis H Dejong  7 , Marcel G Dijkgraaf  8 , Casper H van Eijck  9 , Paul Fockens  1 , Harry van Goor  10 , Hein G Gooszen  11 , Karen D Horvath  12 , Krijn P van Lienden  13 , Hjalmar C van Santvoort  3   5 , Marc G Besselink  5 ; Dutch Pancreatitis Study Group
Collaborators, Affiliations

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

Janneke van Grinsven et al. HPB (Oxford). .

Abstract

Background: The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis are subject to debate. A survey was performed on these topics amongst a group of international expert pancreatologists.

Methods: An online survey including case vignettes was sent to 118 international pancreatologists. The use and timing of fine-needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy were evaluated.

Results: 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. A lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention versus 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention versus 41% non-invasive).

Discussion: 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.

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