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

Jong Jin Hyun, Nadav Sahar, Anand Singla, Andrew S. Ross, Shayan S. Irani, S. Ian Gan, Michael C. Larsen, Richard A. Kozarek, Michael Gluck

    Research output: Contribution to journalArticlepeer-review

    12 Citations (Scopus)


    Background/Aims: 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. Methods: 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. Results: 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). Conclusions: 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.

    Original languageEnglish
    Pages (from-to)215-222
    Number of pages8
    JournalGut and liver
    Issue number2
    Publication statusPublished - 2019 Mar


    • Acute necrotizing
    • Infection
    • Minimally invasive therapy
    • Pancreatitis
    • Spontaneous pancreatic fistulae
    • Walled-off necrosis

    ASJC Scopus subject areas

    • Hepatology
    • Gastroenterology


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