Asian Journal of Research and Reports in Gastroenterology

Step-up Approach for the Management of Acute Necrotizing Pancreatitis (ANP): Single Institution Experience

Deepank Panchal *

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

Saravana Bhoopathi

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

M. Karthikeyan

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

Benet Duraisamy

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

Uma Maheshwaran

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

Krishna Bharath

Department of Surgical Gastroenterology, Tirunelveli Medical College, Tirunelveli, Tamilnadu, India.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Acute necrotizing pancreatitis causing infected pancreatic necrosis is a severe disease with high morbidity and mortality that needs critical care and judicious management decisions. With a step-up approach in the management of acute necrotizing pancreatitis, there is a significant reduction in complications. The aim of this study is to analyze the outcome of the step-up approach in a single tertiary care centre.

Methodology: Prospective observational study conducted between January 2021 and December 2022. Patients with pancreatic necrosis or peripancreatic necrosis detected on contrast-enhanced computed tomography scans were included in the study.

Results: A total of 53 patients were included in the study. Ethanol (75.5%) and biliary (11.3%) were the two most common etiology. 32 patients (60.4%) were managed conservatively initially and 19 (35.8%) with a step-up approach. Interventions were done in 24 patients (45.3%) –image-guided percutaneous drainage-14(26.4%) patients, Percutaneous drainage followed by necrosectomy- 5(9.4%) patients, Conservative management followed by direct necrosectomy -5 (9.4%) Patients. 14(73.7%) Patients were managed with Percutaneous drainage alone successfully. Overall mortality- 4 patients. Primary end points were- mortality 02(10.5%), Enteric fistula 03(15.9%), secondary end points- biliary stricture and Pseudocyst formation 01(5.3%), need of pancreatic enzymes 02(10.5%).

Conclusion: Step-up approach management reduces morbidity and mortality in patients with necrotizing pancreatitis and infected pancreatic necrosis, in two-thirds of patients percutaneous drainage obviated the need for necrosectomy.

Keywords: Infected pancreatic necrosis, walled-off necrosis, percutaneous drainage, direct necrosectomy, pancreatic pseudocyst

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