The Diagnosis and Treatment of Local Complications of Acute Necrotizing Pancreatitis in China: A National Survey.

Xiaowu Dong,John Windsor,Jing Zhou,Lin Gao,Bo Ye,Chinese Acute Pancreatitis Clinical Trials Group (Capctg) ,Weiqin Li,Lu Ke,Anthony Phillips,Wenjian Mao,Zhihui Tong,Gang Li,Jose Celso Ardengh

doi:10.1155/2021/6611149

Abstract

Background The optimal management strategy in acute necrotizing pancreatitis (ANP) is debated, and compliance with current guidelines in China is not known. In this study, we performed a national survey on this topic in China. Methods An online questionnaire about the diagnosis and treatment of local complications of ANP was distributed through a national collaborative network. The local and systemic complications were defined according to the Revised Atlanta Classification. Results There were 321 survey respondents from the 394 who opened the link (response rate 81%) from 208 hospitals located in 30/34 provinces across China. There was a lack of consensus in terms of early diagnosis of infected pancreatic necrosis (IPN) as the respondents chose to depend on clinical symptoms (70/321, 22%), organ failure (82/321, 26%), imaging changes (84/321, 26%), and fine needle aspiration (51/321, 16%), respectively. A “step-up” approach has been widely adopted in patients with IPN (294/321, 92%). The decision for initial intervention (without confirmed/suspected infection) was based on clinical condition, CT imaging, or laboratory indicators for most respondents (229/321, 71%). Conclusion While the “step-up” approach has been widely adopted, there is still significant variation in regard to the diagnosis of infection, the best timing for drainage, and the indications for early intervention.

Highlights

Acute pancreatitis (AP) is one of the most common gastrointestinal disorders and a major cause of acute hospital admission in China [1]
The local complications of AP are responsible for considerable morbidity and have been redefined in the Revised Atlanta Classification (RAC) [2, 6], and there has been a notable evolution in their treatment over the last a few years [7]
The International Pancreas Association and the American Pancreas Association jointly published guidelines recommending that when acute necrotic collections (ANC) has explicitly excluded infections, if organ failure persists for several weeks after onset, intervention therapy may be considered, but preferably not until ANC evolves to walled-off necrosis (WON) [11]

Summary

Introduction

Acute pancreatitis (AP) is one of the most common gastrointestinal disorders and a major cause of acute hospital admission in China [1]. The local complications of AP are responsible for considerable morbidity and have been redefined in the Revised Atlanta Classification (RAC) [2, 6], and there has been a notable evolution in their treatment over the last a few years [7]. The treatment of acute local complications of AP, like acute pancreatic fluid collections (APFC). An online questionnaire about the diagnosis and treatment of local complications of ANP was distributed through a national collaborative network. There was a lack of consensus in terms of early diagnosis of infected pancreatic necrosis (IPN) as the respondents chose to depend on clinical symptoms (70/321, 22%), organ failure (82/321, 26%), imaging changes (84/321, 26%), and fine needle aspiration (51/321, 16%), respectively. While the “step-up” approach has been widely adopted, there is still significant variation in regard to the diagnosis of infection, the best timing for drainage, and the indications for early intervention

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