title: Prognostic significance of differentiating necrosis from fluid collection on endoscopic ultrasound in patients with presumed isolated extrapancreatic necrosis.
abstract: BACKGROUND
  Extrapancreatic necrosis is diagnosed on computed tomography (CT) as extrapancreatic changes that are more than fat stranding; both fluid collections and necrosis would have a similar appearance. The aim of this study was to determine the prognostic significance of differentiating peripancreatic necrosis from fluid collection on endoscopic ultrasound (EUS) in patients with presumed isolated extrapancreatic necrosis.
  
  
  METHODS
  We carried out a retrospective analysis of prospectively collected data from 36 patients (25 males; age range 19-65 years) with acute pancreatitis (AP) and isolated extrapancreatic necrosis. On EUS, peripancreatic anechoic areas were labeled as peripancreatic fluid collections and peripancreatic heterogeneously echotextured areas as peripancreatic necrosis.
  
  
  RESULTS
  The etiology of AP was alcohol in 16 (44.4%) patients, gallstone disease in 13 (36.1%), and other in 7 (19.4%). On EUS, 25 (69.4%) patients had peripancreatic necrosis and 11 (30.6%) patients had peripancreatic fluid collections. Compared with patients who had peripancreatic fluid collections, patients with peripancreatic necrosis had a significantly higher frequency of pleural effusion (88% vs. 55%; P=0.04), organ failure (OF) (68% vs. 27%; P=0.03), and persistent OF (48% vs. 9%; P=0.03). The patients with peripancreatic necrosis also had a higher frequency of ascites (20% vs. 9%), need for intervention (20% vs. nil), surgery (8% vs. nil) and mortality (8% vs. nil), but these differences were not statistically significant.
  
  
  CONCLUSIONS
  Isolated extrapancreatic necrosis on contrast-enhanced CT comprises a heterogeneous group, with patients who show peripancreatic fluid collections on EUS having a less severe disease course compared to patients with peripancreatic necrosis.
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin).
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin); Current affiliation: Fortis Hospital, Mohali, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Chhabra
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin).
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin).
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Surgery (Rajesh Gupta), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology (Surinder S. Rana, Puneet Chhabra, Ravi Sharma, Vishal Sharma, Deepak K. Bhasin); Current affiliation: Fortis Hospital, Mohali, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
keywords: Pancreatitis; endosonography; gallstones; organ failure; pancreatic necrosis