Minimally invasive management of pancreatic abscess, pseudocyst, and necrosis: a systematic review of current guidelines.
BACKGROUND
Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although there are no randomised trials to evaluate these techniques. The aims of this study were to review the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis and identify the degree of consensus between guidelines.


METHODS
A MEDLINE search was performed to identify current guidelines from any professional body published in the English language. Guidelines were analysed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis.


RESULTS
Sixteen guidelines were reviewed. Percutaneous catheter drainage for pancreatic abscess was recommended by eight guidelines; for infected pseudocysts, one guideline did not recommend its use and six recommended its use; for infected necrosis, two guidelines did not recommend its use and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis, endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.


CONCLUSIONS
Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst, and infected necrosis, and few recommendations were graded according to the strength of the evidence. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.
Loveday
Benjamin P T
BP
Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Mittal
Anubhav
A
Phillips
Anthony
A
Windsor
John A
JA
D000038:Abscess / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D016145:Endoscopy, Digestive System; D006801:Humans; D010192:Pancreatic Pseudocyst / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010195:Pancreatitis / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic