RT Journal Article
T1 Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis
A1 Lariño Noia, José
A1 Iglesia García, Daniel de la
A1 González López, Javier
A1 Díaz López, J.
A1 Macías García, Fernando
A1 Mejuto, Rafael
A1 Quiroga, Adriano
A1 Mauriz, Violeta
A1 Jardí, Andrea
A1 Iglesias García, Julio
A1 Domínguez Muñoz, Juan Enrique
K1 Pancreatitis
K1 Endosonography
K1 Carbapenem
K1 Antibiotic resistance
K1 Endoscopic necrosectomy
AB Background : Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. Methods : Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. Results : 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4 weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53%. Conclusions : Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics.
PB Springer
SN 0930-2794
YR 2020
FD 2020-02-19
LK https://hdl.handle.net/10347/38833
UL https://hdl.handle.net/10347/38833
LA eng
NO Lariño-Noia, J., de la Iglesia-García, D., González-Lopez, J. et al. Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis. Surg Endosc 35, 644–651 (2021). https://doi.org/10.1007/s00464-020-07428-4
DS Minerva
RD 26 abr 2026