title: A percutaneous drainage protocol for severe and moderately severe acute pancreatitis.
abstract: BACKGROUND
  According to the revised Atlanta classification, severe and moderately severe acute pancreatitis (AP) includes patients with pancreatic and peripancreatic collections with or without organ failure. These collections suggest the presence of pancreatic juice leakage. The aim of this study was to evaluate the efficacy of a percutaneous catheter drainage (PCD) protocol designed to control leakage and decrease disease severity.
  
  
  METHODS
  Among 663 patients with clinical AP, 122 were classified as moderately severe or severe AP (all had collections). The computed tomography severity index (CTSI) score was calculated. The indication for PCD was based on progressive clinical signs and symptoms. Drain patency, position, and need for additional drainage sites were assessed using CT scans and drain studies initially every 3 days using a proactive protocol. Drain fluid was examined for amylase concentration and microbiological culture. Clinicopathological variables for patients with and without PCD were compared. Since there was no mortality, we used prolonged drainage time to measure the success of PCD. Within the group treated with PCD, variables that resulted in prolonged drainage time were analyzed.
  
  
  RESULTS
  PCD was used in 47/122 (39 %) patients of which 33/47 (70 %) had necrosis. PCD cases had a median CTSI of 8 and were classified as moderately severe AP (57 %) and severe AP (43 %). Inhospital mortality was zero. Surgical necrosectomy was not required for patients with necrosis. Independent risk factors for prolonged drainage time were persistent organ failure >48 h (P = 0.001), CTSI 8-10 (P = 0.038), prolonged duration of amylase-rich fluid in drains (P < 0.001), and polymicrobial culture fluid in drains (P = 0.015).
  
  
  CONCLUSIONS
  A proactive PCD protocol persistently maintaining drain patency advanced to the site of leak controlled the prolonged amylase in drainage fluid resulting in a mortality rate of zero.
authors: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA. msugimot7@gmail.com.
authors: Motokazu
authors: M
authors: Sugimoto
authors: Department of Interventional Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: David P
authors: DP
authors: Sonntag
authors: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Greggory S
authors: GS
authors: Flint
authors: Department of Diagnostic Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Cody J
authors: CJ
authors: Boyce
authors: Department of Diagnostic Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: John C
authors: JC
authors: Kirkham
authors: Department of Interventional Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Tyler J
authors: TJ
authors: Harris
authors: Department of Interventional Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Sean M
authors: SM
authors: Carr
authors: Department of Interventional Radiology, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Brent D
authors: BD
authors: Nelson
authors: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: Joshua G
authors: JG
authors: Barton
authors: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 East Idaho Street, Suite 301, Boise, ID, 83712, USA.
authors: L William
authors: LW
authors: Traverso
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010195:Pancreatitis / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Drainage; Necrosis; Pancreatic fistula; Pancreatic juice; Pancreatitis; Treatment outcome
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