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

Janneke van Grinsven¹, Sandra van Brunschot², Olaf J Bakker³, Thomas L Bollen⁴, Marja A Boermeester⁵, Marco J Bruno⁶, Cornelis H Dejong⁷, Marcel G Dijkgraaf⁸, Casper H van Eijck⁹, Paul Fockens², Harry van Goor¹⁰, Hein G Gooszen¹¹, Karen D Horvath¹², Krijn P van Lienden¹³, Hjalmar C van Santvoort¹⁴, Marc G Besselink¹⁵; Dutch Pancreatitis Study Group

Collaborators, Affiliations

Collaborators

Dutch Pancreatitis Study Group:
M Abdelhafez, R Andersson, A Andren-Sandberg, S Ashley, M van Baal, T Baron, C Bassi, E Bradley, M Buchler, V Cappendijk, R Carter, R Charnley, D Coelho, S Connor, P Dellinger, C Dervenis, J Deviere, N Doctor, V Dudeja, M En-qiang, J Escourrou, P Fagenholz, G Farkas, C Forsmark, M Freeman, P Freeny, J French, H Friess, T Gardner, P Goetzinger, J Haveman, S Hofker, C Imrie, S Isaji, R Isenmann, E Klar, J Laméris, M Lerch, P Lévy, K Lillemoe, M Löhr, J Mayerle, T Mayumi, A Mittal, J Moessner, D Morgan, K Mortele, W Nealon, J Neoptolemos, V Nieuwenhuijs, I Nordback, A Olah, K Oppong, R Padbury, G Papachristou, R Parks, J Poley, D Radenkovic, M Raraty, B Rau, V Rebours, S Rische, M Runzi, N Sainani, M Sarr, S Schaapherder, S Seewald, H Seifert, T Shimosegawa, S Silverman, V Singh, A Siriwardena, W Steinberg, R Sutton, K Takeda, R Timmer, S Vege, R Voermans, J de Waele, Ch Wang, A Warshaw, J Werner, B Weusten, D Whitcomb, J Wig, J Windsor, N Zyromski

Affiliations

¹ Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: j.van.grinsven@antoniusziekenhuis.nl.
² Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
³ Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Dept. of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁵ Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
⁶ Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁷ Dept. of Surgery, Maastricht University Medical Center, Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, The Netherlands.
⁸ Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
⁹ Dept. of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
¹⁰ Dept. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹¹ Dept. of OR/Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹² Dept. of Surgery, University of Washington Medical Center, Seattle, United States.
¹³ Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
¹⁴ Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
¹⁵ Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.

PMID: 26776851
PMCID: PMC4766363
DOI: 10.1016/j.hpb.2015.07.003

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). 2016 Jan.

. 2016 Jan;18(1):49-56.

doi: 10.1016/j.hpb.2015.07.003. Epub 2015 Dec 20.

Authors

Collaborators

Dutch Pancreatitis Study Group:
M Abdelhafez, R Andersson, A Andren-Sandberg, S Ashley, M van Baal, T Baron, C Bassi, E Bradley, M Buchler, V Cappendijk, R Carter, R Charnley, D Coelho, S Connor, P Dellinger, C Dervenis, J Deviere, N Doctor, V Dudeja, M En-qiang, J Escourrou, P Fagenholz, G Farkas, C Forsmark, M Freeman, P Freeny, J French, H Friess, T Gardner, P Goetzinger, J Haveman, S Hofker, C Imrie, S Isaji, R Isenmann, E Klar, J Laméris, M Lerch, P Lévy, K Lillemoe, M Löhr, J Mayerle, T Mayumi, A Mittal, J Moessner, D Morgan, K Mortele, W Nealon, J Neoptolemos, V Nieuwenhuijs, I Nordback, A Olah, K Oppong, R Padbury, G Papachristou, R Parks, J Poley, D Radenkovic, M Raraty, B Rau, V Rebours, S Rische, M Runzi, N Sainani, M Sarr, S Schaapherder, S Seewald, H Seifert, T Shimosegawa, S Silverman, V Singh, A Siriwardena, W Steinberg, R Sutton, K Takeda, R Timmer, S Vege, R Voermans, J de Waele, Ch Wang, A Warshaw, J Werner, B Weusten, D Whitcomb, J Wig, J Windsor, N Zyromski

Affiliations

¹ Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: j.van.grinsven@antoniusziekenhuis.nl.
² Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
³ Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Dept. of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
⁵ Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
⁶ Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁷ Dept. of Surgery, Maastricht University Medical Center, Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, The Netherlands.
⁸ Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
⁹ Dept. of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
¹⁰ Dept. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹¹ Dept. of OR/Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹² Dept. of Surgery, University of Washington Medical Center, Seattle, United States.
¹³ Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
¹⁴ Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
¹⁵ Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.

PMID: 26776851
PMCID: PMC4766363
DOI: 10.1016/j.hpb.2015.07.003

Abstract

Background: 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.

Methods: 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.

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. 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).

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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Figures

**Figure 1**
Baseline characteristics of respondents

**Figure 2**
Results case vignettes: percentage of respondents answered to proceed to invasive intervention of the (peri)pancreatic necrotic collections at day 7, 10, 14, 20 and 30 days after onset of disease

See this image and copyright information in PMC

References

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

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

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