Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

• Published in: Gut and liver Vol. 13; no. 2; pp. 215 - 222
• Main Authors: Hyun, Jong Jin, Sahar, Nadav, Singla, Anand, Ross, Andrew S, Irani, Shayan S, Gan, S Ian, Larsen, Michael C, Kozarek, Richard A, Gluck, Michael
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.03.2019; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: acute necrotizing; infection; minimally invasive therapy; Original; pancreatitis; spontaneous pancreatic fistulae; walled-off necrosis; 내과학; Infection; Minimally invasive therapy; Spontaneous pancreatic fistulae; Walled-off necrosis; acute necrotizing; Pancreatitis
• DOI: 10.5009/gnl18234
• ISSN: 1976-2283

Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.