The Diagnosis and Treatment of Local Complications of Acute Necrotizing Pancreatitis in China: A National Survey.
Journal
Gastroenterology research and practice
ISSN: 1687-6121
Titre abrégé: Gastroenterol Res Pract
Pays: Egypt
ID NLM: 101475557
Informations de publication
Date de publication:
2021
2021
Historique:
received:
22
10
2020
revised:
14
04
2021
accepted:
22
04
2021
entrez:
2
8
2021
pubmed:
3
8
2021
medline:
3
8
2021
Statut:
epublish
Résumé
The optimal management strategy in acute necrotizing pancreatitis (ANP) is debated, and compliance with current guidelines in China is not known. In this study, we performed a national survey on this topic in China. An online questionnaire about the diagnosis and treatment of local complications of ANP was distributed through a national collaborative network. The local and systemic complications were defined according to the Revised Atlanta Classification. There were 321 survey respondents from the 394 who opened the link (response rate 81%) from 208 hospitals located in 30/34 provinces across China. There was a lack of consensus in terms of early diagnosis of infected pancreatic necrosis (IPN) as the respondents chose to depend on clinical symptoms (70/321, 22%), organ failure (82/321, 26%), imaging changes (84/321, 26%), and fine needle aspiration (51/321, 16%), respectively. A "step-up" approach has been widely adopted in patients with IPN (294/321, 92%). The decision for initial intervention (without confirmed/suspected infection) was based on clinical condition, CT imaging, or laboratory indicators for most respondents (229/321, 71%). While the "step-up" approach has been widely adopted, there is still significant variation in regard to the diagnosis of infection, the best timing for drainage, and the indications for early intervention.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal management strategy in acute necrotizing pancreatitis (ANP) is debated, and compliance with current guidelines in China is not known. In this study, we performed a national survey on this topic in China.
METHODS
METHODS
An online questionnaire about the diagnosis and treatment of local complications of ANP was distributed through a national collaborative network. The local and systemic complications were defined according to the Revised Atlanta Classification.
RESULTS
RESULTS
There were 321 survey respondents from the 394 who opened the link (response rate 81%) from 208 hospitals located in 30/34 provinces across China. There was a lack of consensus in terms of early diagnosis of infected pancreatic necrosis (IPN) as the respondents chose to depend on clinical symptoms (70/321, 22%), organ failure (82/321, 26%), imaging changes (84/321, 26%), and fine needle aspiration (51/321, 16%), respectively. A "step-up" approach has been widely adopted in patients with IPN (294/321, 92%). The decision for initial intervention (without confirmed/suspected infection) was based on clinical condition, CT imaging, or laboratory indicators for most respondents (229/321, 71%).
CONCLUSION
CONCLUSIONS
While the "step-up" approach has been widely adopted, there is still significant variation in regard to the diagnosis of infection, the best timing for drainage, and the indications for early intervention.
Identifiants
pubmed: 34335739
doi: 10.1155/2021/6611149
pmc: PMC8286200
doi:
Types de publication
Journal Article
Langues
eng
Pagination
6611149Informations de copyright
Copyright © 2021 Xiaowu Dong et al.
Déclaration de conflit d'intérêts
The authors declare that they have no competing interests.
Références
Gut. 2013 Jan;62(1):102-11
pubmed: 23100216
Trials. 2019 Apr 25;20(1):239
pubmed: 31023380
HPB (Oxford). 2016 Jan;18(1):49-56
pubmed: 26776851
Arch Surg. 2007 Dec;142(12):1194-201
pubmed: 18086987
Gastroenterology. 2011 Oct;141(4):1254-63
pubmed: 21741922
Pancreatology. 2011;11(4):406-13
pubmed: 21894058
Gut. 2017 Nov;66(11):2024-2032
pubmed: 28838972
Ann Surg. 2019 Aug;270(2):348-355
pubmed: 29672416
Ann Surg. 2012 Dec;256(6):875-80
pubmed: 22735715
Curr Gastroenterol Rep. 2004 Aug;6(4):280-6
pubmed: 15245695
Pancreas. 2012 Nov;41(8):1176-94
pubmed: 23086243
Surgery. 2014 Mar;155(3):442-8
pubmed: 24287142
Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15
pubmed: 24054878
Rev Assoc Med Bras (1992). 2019 Feb;65(2):118-122
pubmed: 30892431
Ann Surg. 2008 Feb;247(2):294-9
pubmed: 18216536
Br J Surg. 1998 Feb;85(2):179-84
pubmed: 9501810
Gastroenterology. 2019 May;156(7):1994-2007.e3
pubmed: 30776347
Am J Gastroenterol. 2005 Nov;100(11):2371-2
pubmed: 16279883
Endoscopy. 2018 May;50(5):524-546
pubmed: 29631305
Ann Surg. 2014 Jun;259(6):1201-7
pubmed: 24169172
J Med Internet Res. 2004 Sep 29;6(3):e34
pubmed: 15471760
J Gastrointest Surg. 2018 Sep;22(9):1557-1564
pubmed: 29752684
Pancreatology. 2001;1(3):237-41
pubmed: 12120201
N Engl J Med. 2010 Apr 22;362(16):1491-502
pubmed: 20410514
J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):405-32
pubmed: 25973947
World J Gastroenterol. 2008 Feb 7;14(5):725-30
pubmed: 18205262
Surg Endosc. 2014 May;28(5):1425-38
pubmed: 24399524
Gut. 2004 Sep;53(9):1340-4
pubmed: 15306596
Cleve Clin J Med. 2017 Aug;84(8):639-648
pubmed: 28806163
Br J Surg. 2009 Mar;96(3):267-73
pubmed: 19125434
Nat Rev Gastroenterol Hepatol. 2016 May;13(5):306-12
pubmed: 26956064