Role of Ultrasound-Guided Percutaneous Catheter Drainage in the Management of Infected Pancreatic Necrosis

Background: Percutaneous catheter drainage has been widely accepted in infected necrotizing pancreatitis. Aims: We evaluated clinical safety and efficacy of ultrasound-guided percutaneous catheter drainage in patients with infected pancreatic necrosis. Subjects: Our prospective study included 44 patients who developed infection of peri/pancreatic necrosis. Of these patients, 25 cases received ultrasound-guided PCD study group) whereas 21 cases underwent surgery (control group). Intervention: On admission all patients were treated with fluid therapy, nutritional support, antibiotics, gastrointestinal decompression and analgesics. Ultrasound-guided PCD or surgery were performed in patients who suspected infection of necrotic collection. Conversion to surgery were considered in patients who failed to PCD. Clinical outcomes: primary outcomes were changes in laboratory parameters before and after treatment, recovery days of inflammatory parameters (WBC, CRP). Secondary outcomes were the incidence of complication, mortality and hospital stay. Results: In the study group PCD period was 30 (median) days (9-91, range). PCD was unsuccessful in 9 (36.0%) patients, who required eventually cross over to necrosectomy. All laboratory parameters (WBC, CRP, serum amylase, blood glucose, serum calcium) were improved after therapy compared to before therapy in both groups (p<0.05). The post treatment comparison showed the level of WBC, CRP, serum amylase and blood glucose in the study group were significantly lower than those in the control group (p<0.05). In PCD group recovery days of WBC, CRP was significantly decreased compared to control group (p<0.05). In study group incidence of new-onset organ failure, intra-abdominal bleeding and incisional hernia significantly reduced than those in the control group (p<0.05). Finally, the mortality rate in  the study group was lower than control group and study group had shorter hospital stays compared to control group (p<0.05). Conclusion: Ultrasound-guided PCD can reduce the need of surgical treatment and step-up approach (PCD followed by surgery) may decrease mortality than primary necrosectomy by minimizing pancreatic injury.