title: Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study.
abstract: BACKGROUND
  The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis is subject to debate. We performed a survey on these topics amongst a group of international expert pancreatologists.
  
  
  METHODS
  An online survey including case vignettes was sent to 118 international pancreatologists. We evaluated the use and timing of fine needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy.
  
  
  RESULTS
  The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. Lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention vs. 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention vs. 41% non-invasive).
  
  
  CONCLUSIONS
  The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.
authors.affiliation: Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Dutch Pancreatitis Study Group, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: j.van.grinsven@antoniusziekenhuis.nl.
authors.forename: Janneke
authors.initials: J
authors.lastname: van Grinsven
authors.affiliation: Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Brunschot
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.affiliation: Dept. of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.affiliation: Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.affiliation: Dept. of Surgery, Maastricht University Medical Center, Maastricht and NUTRIM School for Nutrition, Toxicology and Metabolism, The Netherlands.
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Dejong
authors.affiliation: Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marcel G
authors.initials: MG
authors.lastname: Dijkgraaf
authors.affiliation: Dept. of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Dept. of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: Dept. of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Dept. of OR/Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.affiliation: Dept. of Surgery, University of Washington Medical Center, Seattle, United States.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Horvath
authors.affiliation: Dept. of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Krijn P
authors.initials: KP
authors.lastname: van Lienden
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Dept. of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D044963:Biopsy, Fine-Needle; D032921:Consensus; D004322:Drainage / Q000009:adverse effects / Q000639:trends; D004334:Drug Administration Schedule; D019538:Health Care Surveys; D006801:Humans; D007391:International Cooperation; D010180:Pancreatectomy / Q000009:adverse effects / Q000639:trends; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends
chemical_list: D000900:Anti-Bacterial Agents