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Conservative treatment for infected pancreatic necrosis

A study in this month's issue of Gastroenterology investigates the efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis.

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Conservative treatment has recently been shown to be effective for patients with infected pancreatic necrosis, but the data from individual studies are not robust enough to recommend it as the standard of care.

Dr Venigalla Pratap Mouli from India performed a systematic review and meta-analysis of studies related to primary conservative management for infected pancreatic necrosis.

The team searched MEDLINE/PubMed from 1990 to 2012 for studies of a priori protocols for primary conservative treatment, without necrosectomy, for consecutive patients with infected pancreatic necrosis.

The researchers analyzed data from 8 studies, comprising 324 patients with infected pancreatic necrosis who received primary conservative management.

Conservative management was successful for 64% of patients
Gastroenterology

The research team analyzed an additional 4 studies that reported the efficacy of percutaneous drainage in nonconsecutive patients with infected pancreatic necrosis.

Outcome measures were the success of conservative management strategy, need for necrosectomy, and mortality.

The doctors reported that there was significant heterogeneity in results among the studies.

Based on a random effects model, conservative management was successful for 64% of patients, mortality was 12%, and 26% of patients required necrosectomy or additional surgery for complications.

The researchers noted that a separate analysis of 4 studies that reported outcomes of nonconsecutive patients with infected pancreatic necrosis following percutaneous drainage had comparable results.

The team found that of these separate studies, 50% had successful outcomes, mortality was 18%, and 38% of patients required surgery.

Dr Mouli's team concluded, "Conservative management without necrosectomy is a successful approach for 64% of patients with infected pancreatic necrosis."

"This approach has low mortality and prevents surgical necrosectomy."

Gastroenterology 2013: 144: 333-340
13 February 2013

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