Kosin Med J.  2014 Jun;29(1):11-16. 10.7180/kmj.2014.29.1.11.

Systemic Review for The Effectiveness of Current Conservative Treatment in Necrotizing Pancreatitis

• Park J
• Yang U

• KMID: 1882433
• DOI: http://doi.org/10.7180/kmj.2014.29.1.11

Abstract

The standard treatment of pancreatic necrosis has been surgical necrosectomy. There has been debate on whether early surgical intervention can reduced by infected pancreatic necrosis (IPN). Early emergency laparotomy and multiple organ failure remain associated with high mortality. However, reports have presented during the last 10 years of survival of severe acute pancreatitis with medical management. Large and multicenter study showed that about two thirds of patients with necrotizing pancreatitis can be treated conservatively with relatively low mortality. Patients with IPN benefit from postponding intervention and minimal invasive treatment. We reviewed 4 literatures including 2 Korean institute reseached reports concerning non-surgical, conservative treatments of necrotizing pancreatitis including IPN. Large and multicenter study showed that about two thirds of patients with necrotizing pancreatitis can be treated conservatively with relatively low mortality.

Keyword

Acute pancreatitis; Infection; Necrosis; Treatment

MeSH Terms

Emergencies
Humans
Laparotomy
Mortality
Multiple Organ Failure
Necrosis
Pancreatitis*

Reference

1. Mouli VP, Sreenivas V, Garg PK. Efficacy of Conservative Treatment, Without Necrosectomy, for Infected Pancreatic Necrosis: A Systemic Review and Metaanalysis. Gastroenterology. 2013; 144:333–40.

2. Van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, et al. A Conservative and Minimally Invasive Approach to Necrotizing Pancreatitis Improves Outcome. Gastroenterology. 2011; 141:1254–63.

3. Lee JK, Kwak KK, Park JK, Yoon WJ, Lee SH, Ryu JK, et al. The efficacy of nonsurgical treatment of infected pancreatic necrosis. Pancreas. 2007; 34:399–404.

4. Song JH, Seo DW, Byun SW, Koo DH, Bae JH, Lee SS, et al. Outcome of intensive medical treatment in patients with infected severe necrotizing pancreatitis. Korean J Gastroenterol. 2006; 48:337–43.

5. Werner J, Feuerbach S, Uhl W, Buchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005; 54:426–36.

6. Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg. 1997; 21:130–5.

7. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993; 128:586–90.

8. Garg PK, Madan K, Pande GK, Khanna S, Sathyanarayan G, Bohidar NP, et al. Association of extent and infection of pancreatic necrosis with organ failure and death in acute necrotizing pancreatitis. Clin Gastroenterol Hepatol. 2005; 3:159–66.

9. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acucte necrotizing pancreatitis. Br J Surg. 1999; 86:1020–4.

10. Nathens AB, Curtis JR, Beale RJ, Cook DJ, Moreno RP, Romand JA, et al. Management of the critically ill patient with severe acute pancreatitis. Crit Care Med. 2004; 32:2524–36.

11. Johnson CD, Abu-Hilal M. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut. 2004. 531340–4.

12. Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG. Fatal outcome in acute pancreatitis: Its occurrence and early prediction. pancreatology. 2001; 1:237–41.

13. Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, et al. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009; 96:267–73.

14. Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastrenterol. 2006; 101:2379–400.

15. Gurusamy KS, Farouk M, Tweedie JH. UK guidelines for the managemnt of acute pancreatitis: is it time to change? Gut. 2005; 54:1344–5.

16. Wemer J, Feuerbach S, Uhl W, Büchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005; 54:426–36.

17. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP guidelines for surgical management of acute pancreatitis. Pancreatology. 2002; 2:565–73.

18. Forsmark CE, Baillie J. AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA institute technical review on acute pancreatitis. Gastroenterology. 2007; 132:2022–44.

19. Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000; 232:619–26.

20. Mier J, León EL, Castillo A, Robledo F, Blanco R. Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg. 1997; 173:71–5.

21. Fernández-del Castillo C, Rattner DW, Makary MA, Mostafavi A, McGrath D, Warshaw AL. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann Surg. 1998; 228:676–84.

22. Besseolink MG, Verwer TJ, Schoenmaeckers EJ, Buskens E, Ridwan BU, Visser MR, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg. 2007; 142:1194–201.

23. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis; value of CT in establishing prognosis. Radiology. 1990; 174:331–6.

24. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC. Prognostic signs and role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974; 139:69–81.

25. United Kingdom guidelines for the management of acute pancreatitis. British Society of Gastroenterology. Gut. 1998; 42:S1–13.

26. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest. 1992; 101:1644–55.

27. Lee JK, Kwak KK, Park JK, Yoon WJ, Lee SH, Ryu JK, et al. The efficacy of nonsurgical treatment of infected pancreatic necrosis. Pancreas. 2007; 34:399–404.

28. Song JH, Seo DW, Byun SW, Koo DH, Bae JH, Lee SS, et al. Outcome of intensive medical treatments in patients with infected severe necrotizing pancreatitis. Korean J Gastroenterol. 2006; 48:337–43.

29. Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010; 362:1491–502.