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 journalArticle

2 Citations (Scopus)

Abstract

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
Volume13
Issue number2
DOIs
Publication statusPublished - 2019 Mar 1

Fingerprint

Necrosis
Pancreatic Fistula
Therapeutics
Mortality
Length of Stay
Pancreatitis
Intensive Care Units
Drainage
Cause of Death
Hospitalization
Cohort Studies
Multivariate Analysis
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Morbidity

Keywords

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

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy. / Hyun, Jong Jin; Sahar, Nadav; Singla, Anand; Ross, Andrew S.; Irani, Shayan S.; Ian Gan, S.; Larsen, Michael C.; Kozarek, Richard A.; Gluck, Michael.

In: Gut and Liver, Vol. 13, No. 2, 01.03.2019, p. 215-222.

Research output: Contribution to journalArticle

Hyun, JJ, Sahar, N, Singla, A, Ross, AS, Irani, SS, Ian Gan, S, Larsen, MC, Kozarek, RA & Gluck, M 2019, 'Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy', Gut and Liver, vol. 13, no. 2, pp. 215-222. https://doi.org/10.5009/gnl18234
Hyun, Jong Jin ; Sahar, Nadav ; Singla, Anand ; Ross, Andrew S. ; Irani, Shayan S. ; Ian Gan, S. ; Larsen, Michael C. ; Kozarek, Richard A. ; Gluck, Michael. / Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy. In: Gut and Liver. 2019 ; Vol. 13, No. 2. pp. 215-222.
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AU - Sahar, Nadav

AU - Singla, Anand

AU - Ross, Andrew S.

AU - Irani, Shayan S.

AU - Ian Gan, S.

AU - Larsen, Michael C.

AU - Kozarek, Richard A.

AU - Gluck, Michael

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N2 - 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.

AB - 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.

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