Bibliographic Details
| Title: |
Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis. |
| Authors: |
Lariño-Noia, Jose, de la Iglesia-García, Daniel, González-Lopez, Jaime, Díaz-Lopez, Javier, Macías-García, Fernando, Mejuto, Rafael, Quiroga, Adriano, Mauriz, Violeta, Jardí, Andrea, Iglesias-García, Julio, Domínguez-Muñoz, J. Enrique |
| Source: |
Surgical Endoscopy & Other Interventional Techniques; 2021, Vol. 35 Issue 2, p644-651, 8p |
| Subject Terms: |
ANTIBIOTICS, NECROSIS |
| Abstract: |
Background: Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. Methods: Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. Results: 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4 weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53% Conclusions: Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |
