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Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis.
Lariño-Noia, Jose; de la Iglesia-García, Daniel; González-Lopez, Jaime; Díaz-Lopez, Javier; Macías-García, Fernando; Mejuto, Rafael; Quiroga, Adriano; Mauriz, Violeta; Jardí, Andrea; Iglesias-García, Julio; Domínguez-Muñoz, J Enrique.
Afiliación
  • Lariño-Noia J; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain. joselarnoi@outlook.es.
  • de la Iglesia-García D; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • González-Lopez J; Department of Pharmacy, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
  • Díaz-Lopez J; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Macías-García F; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Mejuto R; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Quiroga A; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Mauriz V; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Jardí A; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Iglesias-García J; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
  • Domínguez-Muñoz JE; Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/Choupana S/N, 15706, Santiago de Compostela, Spain.
Surg Endosc ; 35(2): 644-651, 2021 02.
Article en En | MEDLINE | ID: mdl-32076856
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Drenaje / Endoscopía del Sistema Digestivo / Pancreatitis Aguda Necrotizante / Infecciones Intraabdominales / Antibacterianos Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: España Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Drenaje / Endoscopía del Sistema Digestivo / Pancreatitis Aguda Necrotizante / Infecciones Intraabdominales / Antibacterianos Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: España Pais de publicación: Alemania