Endoscopic management for pancreatic injuries due to blunt abdominal trauma decreases failure of nonoperative management and incidence of pancreatic-related complications.
BACKGROUND
The actual benefit of endoscopic techniques in the non-operative management (NOM) of pancreatic injury is still unclear, with its role and effectiveness in the NOM of pancreatic injury remains defined and doubted. The purpose of this study was to evaluate the feasibility and long-term results of endoscopic techniques in the NOM of blunt pancreatic injury, and to determine whether NOM can be performed safely for selective patients with pancreatic injury.


METHODS
The records and follow-up data of all patients with blunt pancreatic injuries over 16-year period from October 1, 1996, to September 30, 2012 at our department were retrospectively reviewed. Failure of NOM (FNOM) occurred if laparotomy was required after attempted NOM.


RESULTS
132 patients (32% of all patients with blunt pancreatic injury) underwent NOM, including 58 who underwent endoscopic management (EM) and 74 who were observed without EM (NO-EM). FNOM of overall NOM was 20%, including 30% of NO-EM and 9% of EM. There was no significant difference in FNOM for NO-EM versus EM for grade I, however, a significant decrease in FNOM was noted with the addition of EM for grade II and III. EM was a statistically significant independent risk factor. Regular follow-up of 1 year showed that, for patients from grade I to III, 53 patients (42%) from operative management (OM) and 34 patients (46%) of the NO-EM developed various pancreatic-related complications, while only 15 patients (26%) of the EM developed such complications, and the difference was significant.


CONCLUSIONS
Application of strictly defined selection criteria for NOM and EM in patients with blunt pancreatic injury resulted in one of the lowest FNOM rates (9%) and pancreatic-related complications incidence (25%). Selective application of EM for hemodynamically stable patients with blunt pancreatic injury will extend the indications for, and improve success of NOM.
Department of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China.
Yalin
Y
Kong
Hongyi
H
Zhang
Xiaojun
X
He
Chengli
C
Liu
Longsong
L
Piao
Gang
G
Zhao
Yuying
Y
Zhen
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D010179:Pancreas / Q000293:injuries / Q000473:pathology*; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
Blunt abdominal trauma; Complication; Endoscopic management; Non-operative management; Pancreatic injury