Document Detail


Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis.
MedLine Citation:
PMID:  20417724     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: The standard treatment for patients with infected pancreatic necrosis (IPN) is surgical necrosectomy. We compared the outcomes of surgical treatment versus primary conservative treatment (patients kept in intensive care unit and treated with antibiotics, organ support, intensive nutritional support, and, if required, percutaneous drainage) among patients with IPN.
METHODS: We performed retrospective comparative (with prospectively acquired database) and prospective observational studies; data were collected from all consecutive patients with acute pancreatitis (n = 804), and those with IPN formed the study group. Patients with IPN were divided into 2 groups on the basis of diagnosis of IPN during 1997-2002 (group 1, n = 30) or 2003-2006 (group 2, n = 50). Eighteen patients in group 1 were treated by surgical necrosectomy, and 40 patients in group 2 were given primary conservative treatment; surgery was performed on patients if conservative treatment failed (n = 10). The primary outcome measure was mortality.
RESULTS: The mortality was comparable in group 1 versus group 2 (43% vs 28%; P = .22). During a period of 10 years, the patients who received primary conservative treatment had significantly higher survival rates than those who received surgery (76.9% vs 46.4%; P = .005). In the prospective study during 2007-2008, the mortality from infected necrosis was 29.6% after primary conservative treatment, confirming the results of the comparative study.
CONCLUSIONS: In treating patients with IPN, a primary conservative strategy resulted in mortality that was comparable with that after surgery, and 76% of the patients were able to avoid surgery; 54.5% of IPN patients were successfully managed with the primary conservative strategy.
Authors:
Pramod Kumar Garg; Manik Sharma; Kaushal Madan; Peush Sahni; Debabrata Banerjee; Rohit Goyal
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-04-24
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  8     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-03     Completed Date:  2011-03-09     Revised Date:  2011-09-21    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1089-1094.e2     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. pkgarg@aiims.ac.in
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Bacterial Agents / therapeutic use*
Debridement*
Drainage / methods*
Endoscopy, Gastrointestinal / methods
Female
Humans
Male
Middle Aged
Pancreatitis, Acute Necrotizing / drug therapy*,  mortality,  surgery*
Prospective Studies
Retrospective Studies
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Comment In:
Gastroenterology. 2011 Aug;141(2):770-2; discussion 772-3   [PMID:  21704038 ]
Clin Gastroenterol Hepatol. 2010 Dec;8(12):1000-1   [PMID:  20816862 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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