Abstract | OBJECTIVE: To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. SUMMARY BACKGROUND DATA: METHODS: A prospective single-center trial evaluated the role of nonsurgical management including early antibiotic treatment in patients with necrotizing pancreatitis. Pancreatic infection, if confirmed by fine-needle aspiration, was considered an indication for surgery, whereas patients without signs of pancreatic infection were treated without surgery. RESULTS: Between January 1994 and June 1999, 204 consecutive patients with acute pancreatitis were recruited. Eighty-six (42%) had necrotizing disease, of whom 57 (66%) had sterile and 29 (34%) infected necrosis. Patients with infected necrosis had more organ failures and a greater extent of necrosis compared with those with sterile necrosis. When early antibiotic treatment was used in all patients with necrotizing pancreatitis ( imipenem/cilastatin), the characteristics of pancreatic infection changed to predominantly gram-positive and fungal infections. Fine-needle aspiration showed a sensitivity of 96% for detecting pancreatic infection. The death rate was 1.8% (1/56) in patients with sterile necrosis managed without surgery versus 24% (7/29) in patients with infected necrosis (P <.01). Two patients whose infected necrosis could not be diagnosed in a timely fashion died while receiving nonsurgical treatment. Thus, an intent-to-treat analysis (nonsurgical vs. surgical treatment) revealed a death rate of 5% (3/58) with conservative management versus 21% (6/28) with surgery. CONCLUSIONS: These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients with infected necrosis still represent a high-risk group in severe acute pancreatitis, and for them surgical treatment seems preferable.
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Authors | M W Büchler, B Gloor, C A Müller, H Friess, C A Seiler, W Uhl |
Journal | Annals of surgery
(Ann Surg)
Vol. 232
Issue 5
Pg. 619-26
(Nov 2000)
ISSN: 0003-4932 [Print] United States |
PMID | 11066131
(Publication Type: Clinical Trial, Journal Article)
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Chemical References |
- Protease Inhibitors
- Thienamycins
- Cilastatin
- Imipenem
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Chi-Square Distribution
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy
- Cilastatin
(therapeutic use)
- Edema
(etiology)
- Female
- Humans
- Imipenem
(therapeutic use)
- Male
- Middle Aged
- Pancreatitis, Acute Necrotizing
(microbiology, mortality, therapy)
- Prospective Studies
- Protease Inhibitors
(therapeutic use)
- Risk Factors
- Sensitivity and Specificity
- Statistics, Nonparametric
- Thienamycins
(therapeutic use)
- Treatment Outcome
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