title: Interventional management of necrotizing pancreatitis: an Australian experience.
abstract: BACKGROUND
  The interventional management of necrotizing pancreatitis has evolved from early open surgery to delayed endoscopic or percutaneous intervention. However, few studies have directly compared the three treatment modalities. We aim to compare the outcomes of patients who had endoscopic, percutaneous or surgical interventions for necrotizing pancreatitis at our institution.
  
  
  METHODS
  This is a retrospective cohort study of patients who had interventions for necrotizing pancreatitis at our institution from 2005 to 2014. Primary outcome was length of stay (LOS); secondary outcomes were complication rate and number of procedures required for resolution of necrosis.
  
  
  RESULTS
  Thirty patients were included. Mortality rate was 13% (four patients). Median LOS and time to intervention was 88 and 28 days, respectively. There were no significant differences in the computed tomography severity indices and 48-h C-reactive protein levels among the three groups. Initial endoscopic intervention was associated with a median LOS of 62 days compared with 101 days in the percutaneous group and 91 days in the surgical group (P = 0.04). There were higher rates of pancreatic fistulae (40%) (P = 0.012) and new onset diabetes (30%) (P = 0.046) in the surgical group. Median number of procedures was similar among the three groups. Median LOS for patients with delayed intervention (fourth to sixth week of pancreatitis) was 66 days, compared with 137 days in patients with early intervention (first to third week) and 104 days in patients with late intervention (seventh week onwards) (P ≤ 0.001).
  
  
  CONCLUSIONS
  A delayed, endoscopy first approach appears to be a reasonable strategy as it is associated with decreased LOS and low complication rate.
authors.affiliation: Department of Upper GI/HPB Surgery, Monash Health, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Shanan
authors.identifier: http://orcid.org/0000-0002-2593-7073
authors.initials: S
authors.lastname: Woo
authors.affiliation: Monash Imaging, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Ryan
authors.initials: R
authors.lastname: Walklin
authors.affiliation: Department of Upper GI/HPB Surgery, Monash Health, Melbourne, Victoria, Australia.
authors.forename: Chandika
authors.initials: C
authors.lastname: Wewelwala
authors.affiliation: Department of Upper GI/HPB Surgery, Monash Health, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Berry
authors.affiliation: Department of Gastroenterology, Monash Health, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Devonshire
authors.affiliation: Department of Upper GI/HPB Surgery, Monash Health, Melbourne, Victoria, Australia.|Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Croagh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: acute necrotizing pancreatitis; pancreatic cystogastrostomy; pancreatic necrosectomy; pancreatic necrosis; percutaneous drainage