Agayeva, Sevda

INTRODUCTION: Early endoscopic intervention of pancreatitis with acute necrotic collection is conflicting with standard practice except in extenuating circumstances. The Atlanta criteria define necrotic collections based on the age from onset of disease as either acute necrotic collections (ANC ≤ 4 weeks) or walled-off necrosis (WON > 4 weeks). Some patients with ANCs will have clinically apparent infection of necrosis potentially necessitating infectious source control via endoscopic intervention where percutaneous drainage is technically challenging or inadequate. At present, data regarding early endoscopic intervention for acute necrotic collections is lacking. METHODS: A retrospective review of patients undergoing endoscopic intervention for pancreatic necrosis between 2008 and 2018 was performed. Included patients had definitive pancreatic/peri-pancreatic necrosis on contrast-enhanced computed tomography, signs/symptoms and laboratory evidence of pancreatitis in relation to hospital presentation, and endoscopic intervention within 28 days of symptom onset. Patients with prior percutaneous or surgical intervention were excluded. ANC cases were matched and compared to WON controls for analyzed parameters via conditional logistic regression. RESULTS: Twenty four patients were identified to have attempted drainage within 28 days of symptom onset, three of which were excluded (imaging limitations, spontaneous drainage/fistulization, unclear date of symptom onset). Demographic and clinical characteristic data are summarized in Table 1, with procedure and outcome characteristics shown in Table 2 for the 21 ANC cases in comparison to WON controls. Overall, ANC cases had slightly larger collections, with statistically significantly longer hospital stays as compared to matched WON controls ( P < 0.01); otherwise measured variables were not statistically significant between the groups. CONCLUSION: There is a paucity of data regarding the safety and efficacy of intervention of ANCs complication pancreatitis. We found in this study that there was reasonable success in clinically indicated endoscopic drainage of ANCs without significant sequelae from the procedures undertaken as compared to matched WON controls. This study demonstrates the safety of intervening on ANCs as early as 15 days if clinically indicated. Further research in regards to efficacy/safety of intervention and prognostic indicators of early intervention is required to further discern whether this applies to general practice of ANC management.