title: A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome.
abstract: OBJECTIVE
  Treatment of patients with necrotizing pancreatitis has become more conservative and less invasive, but there are few data from prospective studies to support the efficacy of this change. We performed a prospective multicenter study of treatment outcomes among patients with necrotizing pancreatitis.
  
  
  METHODS
  We collected data from 639 consecutive patients with necrotizing pancreatitis, from 2004 to 2008, treated at 21 Dutch hospitals. Data were analyzed for disease severity, interventions (radiologic, endoscopic, surgical), and outcome.
  
  
  RESULTS
  Overall mortality was 15% (n=93). Organ failure occurred in 240 patients (38%), with 35% mortality. Treatment was conservative in 397 patients (62%), with 7% mortality. An intervention was performed in 242 patients (38%), with 27% mortality; this included early emergency laparotomy in 32 patients (5%), with 78% mortality. Patients with longer times between admission and intervention had lower mortality: 0 to 14 days, 56%; 14 to 29 days, 26%; and >29 days, 15% (P<.001). A total of 208 patients (33%) received interventions for infected necrosis, with 19% mortality. Catheter drainage was most often performed as the first intervention (63% of cases), without additional necrosectomy in 35% of patients. Primary catheter drainage had fewer complications than primary necrosectomy (42% vs 64%, P=.003). Patients with pancreatic parenchymal necrosis (n=324), compared with patients with only peripancreatic necrosis (n=315), had a higher risk of organ failure (50% vs 24%, P<.001) and mortality (20% vs 9%, P<.001).
  
  
  CONCLUSIONS
  Approximately 62% of patients with necrotizing pancreatitis can be treated without an intervention and with low mortality. In patients with infected necrosis, delayed intervention and catheter drainage as first treatment improves outcome.
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands. h.vansantvoort@umcutrecht.nl
authors: Hjalmar C
authors: HC
authors: van Santvoort
authors: Olaf J
authors: OJ
authors: Bakker
authors: Thomas L
authors: TL
authors: Bollen
authors: Marc G
authors: MG
authors: Besselink
authors: Usama
authors: U
authors: Ahmed Ali
authors: A Marjolein
authors: AM
authors: Schrijver
authors: Marja A
authors: MA
authors: Boermeester
authors: Harry
authors: H
authors: van Goor
authors: Cornelis H
authors: CH
authors: Dejong
authors: Casper H
authors: CH
authors: van Eijck
authors: Bert
authors: B
authors: van Ramshorst
authors: Alexander F
authors: AF
authors: Schaapherder
authors: Erwin
authors: E
authors: van der Harst
authors: Sijbrand
authors: S
authors: Hofker
authors: Vincent B
authors: VB
authors: Nieuwenhuijs
authors: Menno A
authors: MA
authors: Brink
authors: Philip M
authors: PM
authors: Kruyt
authors: Eric R
authors: ER
authors: Manusama
authors: George P
authors: GP
authors: van der Schelling
authors: Tom
authors: T
authors: Karsten
authors: Eric J
authors: EJ
authors: Hesselink
authors: Cornelis J
authors: CJ
authors: van Laarhoven
authors: Camiel
authors: C
authors: Rosman
authors: Koop
authors: K
authors: Bosscha
authors: Ralph J
authors: RJ
authors: de Wit
authors: Alexander P
authors: AP
authors: Houdijk
authors: Miguel A
authors: MA
authors: Cuesta
authors: Peter J
authors: PJ
authors: Wahab
authors: Hein G
authors: HG
authors: Gooszen
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003646:Debridement / Q000009:adverse effects / Q000401:mortality; D004322:Drainage / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D004724:Endoscopy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009426:Netherlands; D018529:Nutritional Support; D016017:Odds Ratio; D010179:Pancreas / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents