8-Years' experience of the interventional and non-interventional treatment of pancreatic and peripancreatic necrosis in patients with severe acute pancreatitis secondary to gallstones and alcohol abuse. A single centre analysis.

Abstract

Background: The treatment of acute pancreatitis (AP) with pancreatic and peripancreatic necrosis (PN and PPN) can be challenging. It is unclear why some patients respond to conservative management while others require an invasive treatment. This study aimed to assess the clinical and radiological characteristics of patients with gallstone or alcohol-induced AP with PN and PPN who underwent interventional or non-interventional treatment.

Methods: Subjects with gallstone or alcohol-induced AP and radiological evidence of PN and PPN, from 2010 to 2018, were divided in two treatment-based groups: interventional-percutaneous drainage (PD) and/or surgical necrosectomy-and non-interventional. A comparison of clinical and radiological characteristics between groups was conducted.

Results: Of 99 patients, 18 underwent interventional treatment, 81 conservative management. The interventional group had larger PN (p = 0.010) and a greater proportion of infected necrosis (p = 0.002). Acute necrotic collection (ANC) >10 cm (95% CI 1.26-3.6, OR 1.839, p = 0.012), infected necrosis (95% CI 4.28-61305.6, OR 153.9, p = 0.026), admission to the intensive care unit (ICU) (95% CI 16.79-326,532.21, OR 489.915, p = 0.007), were predictors of interventions. Patients who underwent PD only had up to four drains inserted and 16.7% hospital mortality; subjects who underwent surgery had up to two drains and 33.3% death rate.

Conclusions: Most subjects with severe gallstone and alcohol-related AP were treated medically. Large ANC, infected necrosis, and ICU admission predicted the need for intervention. When an invasive treatment was required, PD alone was effective with a tendency towards repeated drain insertions.