Success Of Percutaneous Catheter Drainage Research Articles

Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis.

BACKGROUNDEarly prediction of response to percutaneous catheter drainage (PCD) of necrotic collections in acute pancreatitis (AP) using simple and objective tests is critical as it may determine patient prognosis. The role of white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) has not been assessed as a tool of early prediction of PCD success and is the focus of this study.AIMTo assess the value of WBC and NLR in predicting response to PCD in AP.METHODSThis retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019. Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score. WBC and NLR were monitored 24 h prior PCD (WBC-0/NLR-0) and 24 h (WBC-1/NLR-1), 48 h (WBC-2/NLR-2) and 72 h (WBC-3/NLR-3) after PCD. NLR was calculated by dividing the number of neutrophils by the number of lymphocytes. The association of success of PCD (defined as survival without the need for surgery) with WBC and NLR was assessed. The trend of WBC and NLR was also assessed post PCD.RESULTSOne hundred fifty-five patients [median age 40 ± 13.6 (SD), 64.5% males, 53.5% severe AP] were included in the final analysis. PCD was done for acute necrotic collection in 99 (63.8%) patients and walled-off necrosis in 56 (36.1%) patients. Median pain to PCD interval was 24 ± 69.89 d. PCD was successful in 109 patients (group 1) and 46 patients (group 2) who failed to respond. There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure. Both WBC and NLR showed an overall decreasing trend. There was a significant difference between WBC-0 and WBC-1 (P = 0.0001). WBC-1 and NLR-1 were significantly different between the two groups (P = 0.048 and 0.003, respectively). The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682, respectively. At a cut-off value of 9.87 for NLR-1, the sensitivity and specificity for predicting the success of PCD were calculated to be 75% and 65.4% respectively.CONCLUSIONWBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.

Percutaneous catheter drainage in retroperitoneal abscesses: a single centre's 8-year experience.

PurposeWe have investigated the technical and clinical success of percutaneous catheter drainage (PCD) in retroperitoneal abscesses and factors that may affect the outcome.Material and methodsThe study cohort included 45 patients (17 females and 29 males, with mean age of 56.3 years) that were treated between 2012 and 2020. Forty-seven abscesses were managed with PCD under ultrasonography, computed tomography, or fluoroscopy guidance. Patients’ demographics, lesion locations, predisposing factors, clini-cal presentation, etiology, radiological findings, technical factors, and outcome parameters were presented using exploratory and descriptive statistics.ResultsAbscesses were located in the psoas (n = 25, 55.3%), renal-perirenal (n = 7, 14.8%), and pararenal (n = 14, 29.7%) compartments. The mean preprocedural volume was 263.3 (30-1310) ml. Pain (abdominal and back) (57.4%) and fever (17%) were the most frequent presenting symptoms. The most common predisposing factors were previous surgery (n = 17, 36.1%) and diabetes mellitus (n = 11, 25.5%). Clinical success was attained in 89.3% of abscesses (definitive treatment 72.3% and partial success 17.0%). There was a statistically significant difference between the iatrogenic and non-iatrogenic groups regarding clinical success (p = 0.031). No mortality was encountered. The complication rate was 6.6% and were all minor. The average rate of recurrence was 10.6%. The mean time to catheter removal was 15.8 ± 13.2 days.ConclusionsPCD is a safe and effective procedure in the treatment of retroperitoneal abscesses. Procedure-related mortality, morbidity, and complication rates are low. Underlying etiology is a significant factor affecting the outcome. Nevertheless, PCD may provide definitive treatment in the majority of patients.

The effectiveness of image-guided percutaneous catheter drainage in the management of acute pancreatitis-associated pancreatic collections.

PurposeAcute pancreatitis is commonly complicated by the development of pancreatic collections (PCs). Symptomatic PCs warrant drainage, and the available options include percutaneous, endoscopic, and open surgical approaches. The study aimed to assess the therapeutic effectiveness and safety of image guided percutaneous catheter drainage (PCD) in the management of acute pancreatitis related PCs.Material and methodsThis was a single-centre prospective study covering a 4-year study period. Acute pancreatitisrelated PCs complicated by secondary infection or those producing symptoms due to pressure effect on surrounding structures were enrolled and underwent ultrasound or computed tomography (CT)-guided PCD. The patients were followed to assess the success of PCD (defined as clinical, radiological improvement, and the avoidance of surgery) and any PCD-related complications.ResultsThe study included 60 patients (60% males) with a mean age of 43.1 ± 21.2 years. PCD recorded a success rate of 80% (16/20) for acute peripancreatic fluid collections (APFC) and pancreatic pseudocysts (PPs), 75% (12/16) for walled-off necrosis (WON), and 50% (12/24) for acute necrotic collections (ANCs). Post-PCD surgery (necrosectomy ± distal pancreatectomy) was needed in 50% of ANC and 25% of WON. Only 20% of APFCs/PPs patients required surgical/endoscopic treatment post-PCD. Minor procedure-related complications were seen in 4 (6.6%) patients.ConclusionPCD is an effective, safe, and minimally invasive therapeutic modality with a good success rate in the management of infected/symptomatic PCs.

Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis.

One of the critical factors for predicting the success of percutaneous catheter drainage (PCD) is the mean CT density of collection. A higher CT density suggests more necrotic solid tissue within the collection. In the present study, a novel technique for PCD of the necrotic pancreatic collection with a higher mean CT density was evaluated. It was a retrospective study of patients with acute pancreatitis (AP) who underwent PCD of pancreatic collections between May 2018 and December 2018. Patients with pancreatic collections having a CT density of >30 Hounsfield Units (HU) were considered for PCD using the kissing catheter technique. This technique involved placing two catheters side-by-side through a single cutaneous entry site, as the conventional technique of PCD may not be effective. The technical details, outcomes and complications of this technique were recorded. A total of 10 patients with a mean age of 30 years underwent PCD using this technique. All patients had severe pancreatitis with a mean CT severity index of 9 (range, 8-10). The mean CT density was 37 HU (range, 32-56). Successful management with PCD alone was achieved in 8 patients. The other 2 patients underwent surgical necrosectomy. One patient who underwent surgical necrosectomy died. Minor complications occurred in 3 patients. The kissing catheter technique allows for a higher success rate of PCD compared with that of the conventional method of PCD, in collections with a higher mean CT density.

Step-up mini-invasive surgery for infected pancreatic necrosis: Results from prospective cohort study

ObjectivesTo investigate the clinical efficacy and success predictors of mini-invasive techniques in the treatment of infected pancreatic necrosis (IPN). MethodsIPN patients admitted to our clinic for treatment by mini-invasive techniques were included in this study prospectively. Treatment was divided into four sequential phases: percutaneous catheter drainage (PCD), mini-incision drainage (MID), video assisted debridement (VAD) and open surgery. Patients progressed to next phase if the infection cannot be controlled. The frequency of surgery, treatment duration, cure rate, incidence of complication and overall mortality were recorded. Risk factors for failure of PCD and MID procedures were detected by logistic regression including demographics, disease severity and morphologic characteristics. ResultsFrom January 2012 to March 2015, a total of 54 consecutive IPN patients were treated, with an average age of 51.2 ± 3.1 years. Of the 54 cases, 18 (33.3%) were cured after PCD; 13 (24.1%) with uncontrolled infection were cured after MID; and the remaining 19 cases (35.2%) were cured after VAD. No open surgery was performed. Overall mortality was 7.4% (4/54), and the incidence of complications was 12.9% (7/54). In multivariable regression, the following factors were associated with high failure rate for both PCD and MID: heterogeneous fluid collection (odds ratio (OR) = 3.14; 95% confidence interval (CI): 1.32 ～ 4.25, P = 0.001 for PCD; OR = 2.99; 95% CI: 1.52 ～ 5.10, P = 0.006 for MID), multiple infected collections (OR = 4.51; 95% CI: 2.94 ～ 8.63; P = 0.000 for PCD; OR = 4.17; 95% CI: 2.77 ～ 8.12, P = 0.000 for MID), CT severity index (0 ～ 3/4 ～ 6/7 ～ 10: OR = 2.16; 95% CI: 1.83 ～ 3.62, P = 0.031 for PCD; OR = 2.72; 95% CI: 1.78 ～ 4.10, P = 0.005 for MID). ConclusionsStep-up mini-invasive techniques can be considered a first choice in the treatment of IPN. CT is effective to predict success of PCD and MID.

The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis

Percutaneous catheter drainage (PCD) has become popular as a minimally invasive technique in the treatment armamentarium of patients with necrotizing pancreatitis requiring intervention. It obviates surgery and its attendant morbidity in a considerable number of patients in this setting. The aim of the study was to examine whether PCD upfront avoids surgery in a cohort of patients with necrotizing pancreatitis requiring intervention, and to identify factors predicting its failure. We retrospectively reviewed demographic, clinical, and perioperative details of patients with severe acute pancreatitis from January 2009 to December 2011. Of 40 patients with necrotizing pancreatitis admitted to the surgical gastroenterology unit at our institute, 23 patients requiring PCD or surgical intervention were included in this study. Patients with successful and failed PCD were compared to identify factors predictive of failure of PCD. We also compared patients undergoing open necroseotomy with those undergoing PCD upfront, and open necrosectomy in terms of major complications including death. . Surgery was avoided in 7/23 (30%) patients with necrotizing pancreatitis who underwent PCD upfront. Higher APACHE II score (p=0.003) and extent of intrapancreatic necrosis (> 50%, p=0.03) were statistically significant predictors of failure of PCD. Although the complications were not different in patients undergoing PCD upfront followed by surgery, they had lower APACHE II and SOFA scores after PCD and had resolution of organ failures. PCD obviates surgery or acts as a temporizing measure in a significant number of patients with necrotizing pancreatitis. APACHE II scores and extent of intrapancreatic necrosis are principle factors determining success of PCD.