Step-up approach to infected necrotising pancreatitis: A 20-year experience of percutaneous drainage in a single centre

Aim: To evaluate the efficacy of step-up approach to infected necrotising pancreatitis. Methods: Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality. Results: Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86(68.6%) and multiorgan failure in 25/86(29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9-47) and 15(7-34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient. Conclusions: The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.