title: Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre.
abstract: OBJECTIVE
  To evaluate the efficacy of step-up approach to infected necrotising pancreatitis.
  
  
  METHODS
  Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality.
  
  
  RESULTS
  Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86 (68.6%) and multiorgan failure in 25/86 (29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9-47) and 15 (7-34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient.
  
  
  CONCLUSIONS
  The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients.
authors.affiliation: University Clinical Center, Tuzla, Bosnia and Herzegovina. zerem@live.com
authors.forename: Enver
authors.initials: E
authors.lastname: Zerem
authors.forename: Goran
authors.initials: G
authors.lastname: Imamović
authors.forename: Alma
authors.initials: A
authors.lastname: Sušić
authors.forename: Bahrija
authors.initials: B
authors.lastname: Haračić
mesh_terms: D000328:Adult; D002404:Catheterization; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome