title: Better Outcomes if Percutaneous Drainage Is Used Early and Proactively in the Course of Necrotizing Pancreatitis.
abstract: OBJECTIVE
  To compare outcomes after percutaneous catheter drainage (PCD) for acute necrotizing pancreatitis versus those in a randomized controlled trial as a reference standard.
  
  
  METHODS
  Between September 2010 and August 2014, CT-guided PCD was the primary treatment for 39 consecutive patients with pancreatic necrosis. The indication for PCD was the clinical finding of uncontrolled pancreatic juice leakage rather than infected necrosis. Subsequent to PCD, the drains were proactively studied with fluoroscopic contrast medium every 3 days to ensure patency and position. Drains were ultimately maneuvered to the site of leakage. These 39 patients were compared with 43 patients from the Pancreatitis, Necrosectomy versus Step-up Approach (PANTER) trial.
  
  
  RESULTS
  The CT severity index was similar between studies (median of 8 in each). Time from onset of acute pancreatitis to PCD was shorter in the present series (median, 23 d vs 30 d). The total number of procedures (PCD and subsequent fluoroscopic drain studies) per patient was greater in the present series (mean, 14 vs 2). More patients in the PANTER trial had organ failure (62% vs 84%), required open or endoscopic necrosectomy (0% vs 60%), and experienced in-hospital mortality (0% vs 19%; P < .05 for all).
  
  
  CONCLUSIONS
  Even though patients in the present series had a similar CT severity index as those in the PANTER trial, the former group showed lower incidences of organ failure, need for necrosectomy, and in-hospital mortality. The use of a proactive PCD protocol early, before the development of severe sepsis, appeared to be effective.
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712. Electronic address: msugimot7@gmail.com.
authors.forename: Motokazu
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: David P
authors.initials: DP
authors.lastname: Sonntag
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Greggory S
authors.initials: GS
authors.lastname: Flint
authors.affiliation: Department of Diagnostic Radiology, St. Luke's Health System, , 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Cody J
authors.initials: CJ
authors.lastname: Boyce
authors.affiliation: Department of Diagnostic Radiology, St. Luke's Health System, , 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: John C
authors.initials: JC
authors.lastname: Kirkham
authors.affiliation: Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Harris
authors.affiliation: Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Carr
authors.affiliation: Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Brent D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Department of Interventional Radiology, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Don A
authors.initials: DA
authors.lastname: Bell
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Barton
authors.affiliation: Center for Pancreatic and Liver Disease, St. Luke's Health System, 100 E. Idaho St., Suite 301, Boise, ID 83712.
authors.forename: L William
authors.initials: LW
authors.lastname: Traverso
mesh_terms: D000328:Adult; D000368:Aged; D057785:Catheters; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015641:Radiography, Interventional; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome