HP28P MINIMALLY INVASIVE MANAGEMENT OF PANCREATIC ABSCESS, PSEUDOCYST AND NECROSIS: A SYSTEMATIC REVIEW OF CURRENT GUIDELINES

Abstract

Purpose: Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although no randomised trials exist to evaluate these techniques. This study aims to review the scope and quality of recommendations in current clinical guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis; and identify the degree of consensus between guidelines.Methodology: A MEDLINE search identified current guidelines published in English from any professional body. Guidelines were analysed to determine their recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected necrosis.Results: Sixteen guidelines were reviewed. Percutaneous catheter drainage was recommended by eight guidelines for pancreatic abscess; for infected pseudocysts, one guideline did not recommend its use, and six recommended its use; for infected necrosis, two guidelines did not recommend its use, and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.Conclusion: Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst and infected necrosis, and few recommendations included evidence grading. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.