Predictive factors for successful ultrasound-guided percutaneous drainage in necrotizing pancreatitis

Abstract

Background: Percutaneous catheter drainage (PCD) is now regarded as an initial minimal access technique of step-up approach for necrotizing pancreatitis. Factors that led to surgical intervention after initial management with PCD have rarely been reported. This study was to evaluate the safety and efficacy of ultrasound-guided PCD in patients with necrotizing pancreatitis and identify a subgroup of patients where PCD alone would be effective.

Methods: We performed a retrospective review of patients with necrotizing pancreatitis who underwent intervention in West China Hospital from January 1, 2009, to March 31, 2013.

Results: Patients who underwent initial PCD therapy had lower intra-abdominal bleeding rate (41/235 vs. 1/51, P = 0.002), lower enterocutaneous fistula rate (28/235 vs. 0/51, P = 0.004), and lower mortality rate (46/235 vs. 3/51, P = 0.001) when compared with the patients who underwent operative intervention. The successful PCD group had lower computed tomography (CT) mean density of necrotic fluid collection (18 HU vs. 25 HU, P = 0.01) and higher prevalence of walled-off necrosis (20/35 vs. 5/16, P = 0.04) when compared with failed PCD group. Multivariate analysis of the predictors of surgery showed that only CT mean density of necrotic fluid collection [odd ratio (OR) 1.63, 95 % confidence interval (CI) 1.04-2.94, P = 0.006] was identified as significant factor.

Conclusion: CT mean density of necrotic fluid collection and the existence of acute necrotic collection could influence the success rate of PCD.

Keywords: Acute pancreatitis; Operative intervention; Pancreatic necrosis; Percutaneous catheter drainage.