Together We Stand, Divided We Fall: A Multidisciplinary Approach in Complicated Acute Pancreatitis

Trans-gastric and trans-abdominal percutaneous drainage of acute peripancreatic fluid infected collections: A retrospective analysis

Background

Acute pancreatitis is one of the most common gastrointestinal diseases. Approximately 20% of the patients develop peripancreatic collections. Step-up management it's now the best approach with less rate of morbidity and mortality compared with open or minimally invasive surgery. Percutaneous management could reach a success rate between 50 and 76%. Our study shows the outcomes of trans-gastric versus transabdominal percutaneous drainage in cases of acute peripancreatic fluid infected collections in the absence of interventionist endoscopy.

Methods

A retrospective review of a prospectively collected database was conducted. All the patients older than 18 years old that underwent percutaneous drainage between January 2010–December 2021 were included. Analysis and description of outcomes such as mortality, complications, and avoidance of surgical procedures was performed.

Results

18 patients underwent percutaneous drainage. 66.67% of patients were male. Mean age was 52.55 ± 22.06 years. Mean weight was 74.43 ± 15.25 kg. Mean size of peripancreatic collections 118.4 ± 49.12 mm. Wall-off necrosis was present in 33.33%. Trans-gastric approach was performed in 50% of the cases, the rest was trans-abdominal. No mortality was evidenced after 30 days of follow up. After trans-gastric percutaneous drainage, all patients avoided surgical open or laparoscopic procedure.

Conclusion

Standardized step-up approach shows increased rates of success in percutaneous drainage of peripancreatic collections. Our case series shows a high rate of success in terms of avoidance any surgical procedure with no mortality after trans-abdominal and trans-gastric percutaneous drainage. Nevertheless, further prospective studies with higher sample size are needed.

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Trans-gastric and trans-abdominal percutaneous drainage of peripancreatic infected collections are safe and feasible procedures.

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In cases of no access to interventional endoscopy, percutaneous drainage remains to be a safe procedure.

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Multidisciplinary approach leads to good outcomes with less rate of morbidity and mortality.

Advances in acute pancreatitis

PURPOSE OF REVIEW

With a potentially life-threatening course, acute pancreatitis (AP) is one of the most common gastrointestinal diseases requiring hospitalization and often necessitating intensive care. Based on recent insights and recommendations, this review provides an overview on clinical management of AP patients with a focus on intensive care unit care.

RECENT FINDINGS

Possible benefits of percutaneous paracentesis and/or drainage on outcome or inflammation have been further explored. Combined opioid and epidural analgesia for pain management might be a valuable alternative for pain management. Very recent international guidelines now agree on a step-up approach for the management of acute necrotizing pancreatitis favoring a minimally invasive approach with either endoscopic or percutaneous drainage first. Studies for the best timing of these interventions are ongoing. In spite of a better understanding of pathophysiological mechanisms mediating AP, specific treatments are still awaited.

SUMMARY

New evidence and recent international consensus direct the current management of AP toward a tailored, multidisciplinary and less invasive therapy with complementary roles for hepatologists, intensivists, radiologists, and surgeons.

Bibliometric analysis of acute pancreatitis in Web of Science database based on CiteSpace software

OBJECTIVES

Recent years have witnessed some controversial viewpoints in clinical and basic research, which exert a great influence on the research trend of acute pancreatitis (AP). We aimed to analyze the literature on AP by metrology, co-occurrence, co-citation, and visualization, and to explore the research status and trend in this field in the past 5 years.

METHODS

The relevant literature collected in Web of Science Core Collection (WoSCC) database from 2015 to 2019 was searched using "acute pancreatitis" as the title word, and the co-occurrence analysis of authors, institutions, countries, and keywords was carried out by using CiteSpace V. On this basis, the keywords were clustered and analyzed by using VOSviewer 1.6.8 and Carrot 2 software, and a visual map was drawn.

RESULTS

A total of 2035 articles were included, with an average annual volume of more than 400. The high-yield authors were mainly Chinese, among which Li WQ was the most prominent. Most of these articles were from universities and institutions of high-yielding countries including China, the United States, and India. The main sources of journals were professional journals, among which Pancreas and Pancreatology have the most literature collection volume (both over 100), including clinical and basic research. Among the funds, the National Natural Science Foundation of China and NIH were the main 2 sponsors. Disciplinary attributes involved multiple subjects such as gastroenterology, internal medicine, and surgery. Keyword co-occurrence and clustering results showed that the classification, mortality, and risk factors of AP were still more concerned, and the research trend of this disease was the molecular mechanism of the severity of AP.

CONCLUSIONS

CiteSpace can be used to analyze the knowledge graph of AP, to show its development status initially and intuitively, and to provide a reference for topic content and its further development.