OPTIMIZED CONCEPT FOR THE TREATMENT OF ACUTE PANCREATITIS IN PATIENTS

Abstract

Background: Current guidelines recommend fine needle aspiration (FNA) in patients with severe acute pancreatitis (SAP) and signs of sepsis. Infected necrosis is an indication for surgery. We found high mortality in patients operated early in the course of the disease. Currently we treat patients with SAP conservatively without FNA. We evaluated the impact of this concept on outcome in SAP. Methods: Prospective analysis of patients with SAP since 09/2003 (group 1) and comparison with retrospectively analyzed patients from 03/2000 until 08/2003 (group 2). Results: Group 1: 20 consecutive patients with SAP were treated according to the new concept. All patients required ICU treatment. One patient had early surgery and died. Six pts. needed late surgery due to secondary complications and survived. One out of 13 conservatively treated patient died. CT-guided drainage was performed in one patient with abdominal compartment due to pseudocyst formation. All patients in group 2 were operated following positive FNA. 9 patients died in this group. Degree of pancreatic damage was the same in both groups as well as percentage of endocrine insufficiency. All pts of both groups received antibiotic prophylaxis. Prognostic scores indicated a severe course of the disease in both groups (no statistical difference): APACHE II was 16 ± 2.2 (group 1) vs. 19.8 ± 1.7 (group 2) and SOFA score 6.5 ± 1.1 and 8.7 ± 1.4, respectively. CRP on day 3 was 283 ± 25 (group 1) and 243 ± 21 in group 2, CTSI score was 7.9 ± 0.5 (group 1) and 7.8 ± 0.5 (group 2). Only mortality differed significantly with 10% in group 1 vs. 45 % in group 2. Conclusion: Patients with SAP treated conservatively without FNA had a significant lower mortality compared with patients treated in accordance to current guidelines. Difference in treatment included avoidance of FNA and surgery within the first 3-4 weeks. We suggest that FNA should be avoided within the first 3 weeks of SAP in a stable patient regardless of secondary organ complications since surgery increases mortality during this early phase independent from the infection of pancreatic necrosis.