Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients.
OBJECTIVE
To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis.


METHODS
Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30-120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid.


RESULTS
All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7-32 (average, 17) episodes of debridement and stayed 0-36 days (average, 9 days) in the intensive care unit, 13-118 days (average, 42 days) on the regular floor, and spent 0-98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred.


CONCLUSIONS
Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis.
Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, FL 33136, USA.
A M
AM
Echenique
D
D
Sleeman
J
J
Yrizarry
T
T
Scagnelli
J J
JJ
Guerra
V J
VJ
Casillas
H
H
Huson
E
E
Russell
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation*; D003646:Debridement / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D012086:Reoperation; D013396:Suction / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome