Aggressive Percutaneous Catheter Drainage Protocol for Necrotic Pancreatic Collections

• Published in: Digestive diseases and sciences 2020-12, Vol.65 (12), p.3696-3701
• Main Authors: Gupta, Pankaj, Gupta, Jyoti, Kumar, Chandan, Samanta, Jayanta, Mandavdhare, Harshal, Sharma, Vishal, Sinha, Saroj K., Gupta, Vikas, Yadav, Thakur Deen, Dutta, Usha, Kochhar, Rakesh
• Format: Article
• Language: English
• Subjects: Abdomen; Antibiotics; Biochemistry; Catheters; Catheters, Indwelling - statistics & numerical data; Clinical Protocols; Collections; Endoscopy; Endoscopy - methods; Female; Gastroenterology; Health aspects; Hepatology; Hospitals; Humans; India - epidemiology; Length of Stay - statistics & numerical data; Male; Medical care; Medical education; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Oncology; Original Article; Outcome and Process Assessment, Health Care; Pain; Pancreatitis; Pancreatitis, Acute Necrotizing - diagnosis; Pancreatitis, Acute Necrotizing - mortality; Pancreatitis, Acute Necrotizing - surgery; Paracentesis - instrumentation; Paracentesis - methods; Quality management; Surgery; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Survival Analysis; Tomography, X-Ray Computed - methods; Transplant Surgery; Ultrasonography, Interventional - methods
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-020-06116-6

Background Percutaneous catheter drainage (PCD) performed pro-actively for collections in acute pancreatitis (AP) is associated with better outcomes. However, there are only a few studies describing this protocol. Aim We aimed to evaluate an aggressive PCD protocol. Methods Consecutive patients with AP who underwent PCD with an aggressive protocol between January 2018 and January 2019 were included. This protocol involved catheter upsizing at a pre-specified interval (every 4–6 days) as well as drainage of all the new collections. The indications and technical details of PCD and clinical outcomes were compared with patients who underwent standard PCD. Results Out of the 185 patients with AP evaluated during the study period, 110 (59.4%) underwent PCD, all with the aggressive protocol. The historical cohort of standard PCD comprised of 113 patients. There was no significant difference in the indication of PCD and interval from pain onset to PCD between the two groups. The mean number of catheters was significantly higher in the aggressive PCD group (1.86 ± 0.962 vs. 1.44 ± 0.667, p  = 0.002). Additional catheters were inserted in 54.2% of patients in aggressive group vs. 36.2% in the standard group ( p  = 0.006). Length of hospital stay and intensive care unit (ICU) stay were significantly longer in the standard PCD group (34.3 ± 20.14 vs. 27.45 ± 14.2 days, p