Evaluation of the clinical effect of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infectious pancreatic necrosis: a retrospective, historical control study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEN Jun ¹ , DAN Jing ² , WU Pengyu ² , JIANG Cuinan ¹ , LÜ Hailong ¹ , REN Bo ¹ , ZHANG Rong ¹ ,  PAN Chuanliang ³

1. Section for Hepato-Pancreato-Biliary Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
2. Department of Digestive Medicine, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;
3. Department of Intensive Care Unit, The Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu 610014, P. R. China;

Corresponding author：

PAN Chuanliang, Email: cl.pan@foxmail.com

Keywords：

acute pancreatitis; infected pancreatic necrosis; endoscopic ultrasound; surgical intervention; prognosis

DOI：

10.7507/1007-9424.202402009

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Objective To evaluate the clinical efficacy of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infected pancreatic necrosis (IPN). Methods A retrospective, historical control study was conducted. A total of 98 patients with acute pancreatitis (AP) complicated with IPN who met the inclusion and exclusion criteria and were admitted to the Third People’s Hospital of Chengdu from June 2016 to January 2023 were selected as the research objects. The endoscopic ultrasound-guided transluminal drainage was carried out in our hospital in June 2020. In this study, patients treated before May 2020 were divided into the non-EUS group (52 cases), and patients treated after June 2020 were divided into the EUS group (46 cases). The baseline data, surgical intervention, length of hospital stay, length of intensive care unit (ICU) stay, infection time, incidence of multiple organ dysfunction syndrome (MODS), survival situation, short-term and long-term complications, and other indicators were compared between the two groups. Results The number of percutaneous catheter drainage (PCD, 1.0 vs. 1.0), the number of PCD drainage tube (1.0 vs. 2.0), the number of retroperitoneal debridement drainage (1.0 vs. 2.0), the total length of hospital stay (42.0 d vs. 45.5 d), the length of ICU stay (11.0 d vs. 14.0 d), the length of infection time (10.5 d vs. 18.5 d), the incidences of MODS [43.5% (20/46) vs. 67.3% (35/52)] and residual infection [28.3% (13/46) vs.48.1% (25/52)] in the EUS group were shorter (or lower) than those in the non-EUS group (P<0.05); but there were no significant differences in the number of endoscopic pancreatic stent implantation, the number of laparotomy, the number of laparoscopic surgery, and the incidences of abdominal bleeding, gastrointestinal fistula, gastrointestinal obstruction, chronic pancreatic fistula, chronic pancreatitis and incisional hernia between the two groups (P>0.05). Conclusion For patients with AP complicated with IPN, surgical intervention combined with endoscopic ultrasound-guided transluminal drainage can reduce the number of PCD and drainage tube, shorten the total length of hospital stay, the length of ICU stay and infection, as well as reduce the incidences of MODS and residual infection.

Citation： WEN Jun, DAN Jing, WU Pengyu, JIANG Cuinan, LÜ Hailong, REN Bo, ZHANG Rong, PAN Chuanliang. Evaluation of the clinical effect of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infectious pancreatic necrosis: a retrospective, historical control study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 175-181. doi: 10.7507/1007-9424.202402009 Copy

1.	van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
2.	Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.e3.
3.	孙备, 李冠群. 创伤递升式分阶段治疗感染性胰腺坏死再认识. 中国实用外科杂志, 2021, 41(4): 374-378.
4.	van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
5.	Ocampo C, Zandalazini H, Alonso F, et al. A multimodal approach for the first-line treatment of infected pancreatic necrosis. Pancreas, 2020, 49(6): 757-762.
6.	Castellanos G, Piñero A, Doig LA, et al. Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience. Surg Endosc, 2013, 27(2): 443-453.
7.	董元航, 姜春晖, 郭威, 等. 鼻胃镜和常规胃镜在经皮内镜胰腺坏死组织清除术中的应用对比研究. 中华消化内镜杂志, 2019, 36(11): 815-820.
8.	Albers D, Meining A, Hann A, et al. Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: early intervention does not compromise outcome. Endosc Int Open, 2021, 9(3): E490-E495.
9.	杨歆, 孙玲, 黄其密, 等. 内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析. 第三军医大学学报, 2019, 41(2): 137-142.
10.	Zhang JB, Sun B. Comparison between video-assisted retroperitoneal debridement and small incision pancreatic necrosectomy in infected pancreatic necrosis. ANZ J Surg, 2020, 90(10): 2020-2025.
11.	Bang JY, Arnoletti JP, Holt BA, et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1027-1040.
12.	Onnekink AM, Boxhoorn L, Timmerhuis HC, et al. Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis (ExTENSION): long-term follow-up of a randomized trial. Gastroenterology, 2022, 163(3): 712-722.e14.
13.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
14.	鲁天麒, 尚莅人, 别凡, 等. 感染性胰腺坏死的影像学分型及其治疗效果分析 (附126例病例报告). 中华外科杂志, 2023, 61(1): 33-40.
15.	刘云飞, 尚明铭, 罗东, 等. 超声内镜下穿刺引流治疗感染性胰腺坏死: 附60例报告. 中国普通外科杂志, 2019, 28(3): 306-312.
16.	van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet, 2018, 391(10115): 51-58.
17.	曹锋, 李昂, 高崇崇, 等. 感染性胰腺坏死分区与腹腔镜手术入路选择临床研究. 中国实用外科杂志, 2020, 40(4): 457-460, 464.
18.	隋宇航, 孙备. 感染性胰腺坏死分型的初探与外科干预策略的再思考. 中华外科杂志, 2021, 59(7): 601-607.
19.	高堃, 童智慧, 李维勤. 胰腺坏死组织感染的影像学特征、微创介入方式及时机. 中国实用外科杂志, 2019, 39(6): 575-580.
20.	蔡阳, 殷俊杰. 重症急性胰腺炎外科干预时机与策略的研究进展. 中华肝胆外科杂志, 2023, 29(4): 241-245.
21.	Shenvi S, Gupta R, Kang M, et al. Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage. Pancreatology, 2016, 16(5): 778-787.
22.	van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
23.	Gao L, Zhang H, Li G, et al. The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis. J Gastroenterol, 2022, 57(6): 397-406.
24.	Trikudanathan G, Tawfik P, Amateau SK, et al. Early (<4 weeks) versus standard (≥ 4 weeks) endoscopically centered step-up interventions for necrotizing pancreatitis. Am J Gastroenterol, 2018, 113(10): 1550-1558.
25.	van Grinsven J, van Brunschot S, van Baal MC, et al. Natural history of gas configurations and encapsulation in necrotic collections during necrotizing pancreatitis. J Gastrointest Surg, 2018, 22(9): 1557-1564.
26.	Garg PK, Zyromski NJ, Freeman ML. Infected necrotizing pancreatitis: evolving interventional strategies from minimally invasive surgery to endoscopic therapy-evidence mounts, but one size does not fit all. Gastroenterology, 2019, 156(4): 867-871.

1. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
2. Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.e3.
3. 孙备, 李冠群. 创伤递升式分阶段治疗感染性胰腺坏死再认识. 中国实用外科杂志, 2021, 41(4): 374-378.
4. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
5. Ocampo C, Zandalazini H, Alonso F, et al. A multimodal approach for the first-line treatment of infected pancreatic necrosis. Pancreas, 2020, 49(6): 757-762.
6. Castellanos G, Piñero A, Doig LA, et al. Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience. Surg Endosc, 2013, 27(2): 443-453.
7. 董元航, 姜春晖, 郭威, 等. 鼻胃镜和常规胃镜在经皮内镜胰腺坏死组织清除术中的应用对比研究. 中华消化内镜杂志, 2019, 36(11): 815-820.
8. Albers D, Meining A, Hann A, et al. Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: early intervention does not compromise outcome. Endosc Int Open, 2021, 9(3): E490-E495.
9. 杨歆, 孙玲, 黄其密, 等. 内镜下覆膜金属支架置入引流治疗胰腺坏死感染和假性囊肿13例及文献分析. 第三军医大学学报, 2019, 41(2): 137-142.
10. Zhang JB, Sun B. Comparison between video-assisted retroperitoneal debridement and small incision pancreatic necrosectomy in infected pancreatic necrosis. ANZ J Surg, 2020, 90(10): 2020-2025.
11. Bang JY, Arnoletti JP, Holt BA, et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1027-1040.
12. Onnekink AM, Boxhoorn L, Timmerhuis HC, et al. Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis (ExTENSION): long-term follow-up of a randomized trial. Gastroenterology, 2022, 163(3): 712-722.e14.
13. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
14. 鲁天麒, 尚莅人, 别凡, 等. 感染性胰腺坏死的影像学分型及其治疗效果分析 (附126例病例报告). 中华外科杂志, 2023, 61(1): 33-40.
15. 刘云飞, 尚明铭, 罗东, 等. 超声内镜下穿刺引流治疗感染性胰腺坏死: 附60例报告. 中国普通外科杂志, 2019, 28(3): 306-312.
16. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet, 2018, 391(10115): 51-58.
17. 曹锋, 李昂, 高崇崇, 等. 感染性胰腺坏死分区与腹腔镜手术入路选择临床研究. 中国实用外科杂志, 2020, 40(4): 457-460, 464.
18. 隋宇航, 孙备. 感染性胰腺坏死分型的初探与外科干预策略的再思考. 中华外科杂志, 2021, 59(7): 601-607.
19. 高堃, 童智慧, 李维勤. 胰腺坏死组织感染的影像学特征、微创介入方式及时机. 中国实用外科杂志, 2019, 39(6): 575-580.
20. 蔡阳, 殷俊杰. 重症急性胰腺炎外科干预时机与策略的研究进展. 中华肝胆外科杂志, 2023, 29(4): 241-245.
21. Shenvi S, Gupta R, Kang M, et al. Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage. Pancreatology, 2016, 16(5): 778-787.
22. van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
23. Gao L, Zhang H, Li G, et al. The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis. J Gastroenterol, 2022, 57(6): 397-406.
24. Trikudanathan G, Tawfik P, Amateau SK, et al. Early (<4 weeks) versus standard (≥ 4 weeks) endoscopically centered step-up interventions for necrotizing pancreatitis. Am J Gastroenterol, 2018, 113(10): 1550-1558.
25. van Grinsven J, van Brunschot S, van Baal MC, et al. Natural history of gas configurations and encapsulation in necrotic collections during necrotizing pancreatitis. J Gastrointest Surg, 2018, 22(9): 1557-1564.
26. Garg PK, Zyromski NJ, Freeman ML. Infected necrotizing pancreatitis: evolving interventional strategies from minimally invasive surgery to endoscopic therapy-evidence mounts, but one size does not fit all. Gastroenterology, 2019, 156(4): 867-871.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation of the clinical effect of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infectious pancreatic necrosis: a retrospective, historical control study

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