Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications.
However, there are no randomized trials to evaluate these techniques.
Dr Benjamin Loveday and colleagues from New Zealand reviewed the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage.
The researchers evaluated endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis.
In addition, the researchers identified the degree of consensus between guidelines.
The team performed a MEDLINE search to identify current guidelines from any professional body published in the English language.
|Percutaneous catheter drainage for pancreatic abscess was recommended by 8 guidelines|
|World Journal of Surgery|
Guidelines were analyzed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis.
The researchers reviewed 16 guidelines.
Percutaneous catheter drainage for pancreatic abscess was recommended by 8 guidelines.
For infected pseudo cysts, the research team noted that 1 guideline did not recommend drainage, and 6 recommended its use.
For infected necrosis, 2 guidelines did not recommend its use, and 4 recommended its use.
Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by 7 guidelines.
For infected necrosis, endoscopic management was recommended by 10 guidelines.
The research team observed that 10 guidelines did not include levels of evidence to support their recommendations.
Dr Loveday’s team concluded, “Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudo cyst, and infected necrosis.
“Few recommendations were graded according to the strength of the evidence.”
“More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.”