• Colon fistula
• Infected necrotizing pancreatitis
• Outcomes
• Pancreatic fistula
• Surgery

• Humans
• Male
• Pancreatitis, Acute Necrotizing/surgery
• Pancreatitis, Acute Necrotizing/complications
• Female
• Pancreatic Fistula/etiology
• Pancreatic Fistula/epidemiology
• Adult
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Intestinal Fistula/etiology
• Intestinal Fistula/surgery
• Retrospective Studies
• Colonic Diseases/surgery
• Colonic Diseases/etiology
• Incidence
• Middle Aged

• Acute necrotizing pancreatitis
• Delayed necrosectomy
• Early necrosectomy
• Mortality
• Pancreatic necrosis
• Readmission, Healthcare costs

• LAMS
• WON
• WOPN
• acute pancreatitis
• bacteria
• microbiota
• necrosis microbiome
• pancreatic necrosis

• ACUTE PANCREATITIS
• INTERVENTIONAL RADIOLOGY
• PANCREATIC SURGERY
• PANCREATITIS
• THERAPEUTIC ENDOSCOPY

• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/surgery
• Follow-Up Studies
• Quality of Life
• Prospective Studies
• Exocrine Pancreatic Insufficiency/etiology
• Pancreatitis, Chronic/complications
• Drainage/adverse effects
• Necrosis
• Treatment Outcome

• EUS
• ablation
• celiac plexus neurolysis
• drainage
• pancreatic diseases
• treatment

• akute pankreatitis
• endosonografische drainage
• milzruptur
• milzembolisation
• walled-off necrosis
• acute pancreatitis
• endosonographic drainage
• splenic rupture
• splenic embolization

• Female
• Humans
• Middle Aged
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Shock, Hemorrhagic/diagnosis
• Shock, Hemorrhagic/etiology
• Shock, Hemorrhagic/therapy
• Acute Disease
• Stents
• Drainage/methods
• Splenic Rupture/diagnostic imaging
• Splenic Rupture/etiology
• Necrosis
• Hematoma/diagnosis
• Hematoma/diagnostic imaging
• Treatment Outcome

• acute pancreatitis
• decision curve analysis
• nomogram
• prediction model
• risk factor

• There is no funding to report

Infected necrotizing pancreatitis (INP) represents a severe condition in patients with acute pancreatitis. Invasive interventions are recommended in symptomatic INP. Growing evidence has suggested interventional strategies of INP evolving from traditional surgery to minimally invasive step-up endoscopic procedures. However, there is still no standardized protocol for endoscopic interventions. Recently, various studies have been published about the endoscopic management of INP. This article reviews published articles and guidelines to present the progress and challenges of endoscopic transluminal drainage and necrosectomy in INP.

• Endoscopic
• Drainage
• Necrosectomy
• Infected necrotizing pancreatitis
• Progress
• Challenge

• acute necrotic collections
• infected pancreatic necrosis
• minimally invasive interventions
• pancreas
• percutaneous catheter drainage

• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/surgery
• Treatment Outcome
• Minimally Invasive Surgical Procedures/adverse effects
• Minimally Invasive Surgical Procedures/methods
• Intraabdominal Infections
• Drainage/adverse effects
• Drainage/methods
• Necrosis/diagnosis
• Necrosis/etiology
• Necrosis/surgery

• infected pancreatic necrosis
• minimally invasive methods of surgical treatment
• open methods of surgical treatment

• Atlanta classification
• Drainage
• Infections
• Necrosectomy
• Pancreatitis
• Risk stratification

• ANC
• LAMS
• WON
• interventional EUS
• pancreatitis
• stent

There is growing evidence supporting the substantial, essential and indispensable role of endoscopic ultrasound (EUS) as a key diagnostic armamentarium for upper GI oncologic surgery. Well described in countless publications, EUS holds that position in gastroenterological expert centers all over Europe. Despite its undisputable contributions to oncologic upper GI surgery, the availability of this technique at the expert level shows up in an irregular spread pattern. Endoscopic ultrasound’s primary use during the first few years after its creation was the detection of pancreatic cancer. From then on, EUS developed in different directions, becoming a diagnostic tool that increasingly better defines its status as a method of minimally invasive therapeutic applications and a useful addition to surgical options. As a result, several surgical interventions could even be replaced by ultrasound-targeted interventions. This process took place in just a few years and was made possible by technical development that sensibly combined high-resolution ultrasound with therapeutic endoscopy. The present article will serve to cover the most prevalent uses with supporting data considering the growing list of suggested indications for EUS while also examining cutting-edge initiatives that might soon become the standard of clinical practice. Endoscopic centers with high expertise are needed to train future experts in the growing field of EUS interventions.

Recent guidelines advocate a step-up approach for managing suspected infected pancreatic necrosis (IPN) during acute pancreatitis. Nearly half the patients require secondary necrosectomy after catheter drainage. Our primary objective was to assess the external validity of a previously reported nomogram for catheter drainage, based on four predictors of failure. Our secondary objectives were to identify other potential predictors of catheter-drainage failure. We retrospectively studied consecutive patients admitted to the intensive care units (ICUs) of three university hospitals in France between 2012 and 2016, for severe acute pancreatitis with suspected IPN requiring catheter drainage. We assessed drainage success and failure rates in 72 patients, with success defined as survival without subsequent necrosectomy and failure as death and/or subsequent necrosectomy required by inadequate improvement. We plotted the receiver operating characteristics (ROC) curve for the nomogram and computed the area under the curve (AUROC).

Catheter drainage alone was successful in 32 (44.4%) patients. The nomogram predicted catheter-drainage failure with an AUROC of 0.71. By multivariate analysis, catheter-drainage failure was independently associated with a higher body mass index [odds ratio (OR), 1.12; 95% confidence interval (95% CI), 1.00–1.24; P = 0.048], heterogeneous collection (OR, 16.7; 95% CI, 1.83–152.46; P = 0.01), and respiratory failure onset within 24 h before catheter drainage (OR, 18.34; 95% CI, 2.18–154.3; P = 0.007).

Over half the patients required necrosectomy after failed catheter drainage. Newly identified predictors of catheter-drainage failure were heterogeneous collection and respiratory failure. Adding these predictors to the nomogram might help to identify patients at high risk of catheter-drainage failure.

ClinicalTrials.gov number: NCT03234166.

The online version contains supplementary material available at 10.1186/s13613-022-01039-z.

• Acute pancreatitis
• Catheter drainage
• Infected necrosis
• Intensive care
• Necrosectomy
• Organ failure

Acute pancreatitis (AP) is one of the most common gastrointestinal diseases and remains a life-threatening condition. Although AP resolves to restitutio ad integrum in approximately 80% of patients, it can progress to necrotizing pancreatitis (NP). NP is associated with superinfection in a third of patients, leading to an increase in mortality rate of up to 40%. Accurate and early diagnosis of NP and associated complications, as well as state-of-the-art therapy are essential to improve patient prognoses. The emerging role of endoscopy and recent trials on multidisciplinary management of NP established the “step-up approach”. This approach starts with endoscopic interventions and can be escalated to other interventional and ultimately surgical procedures if required. Studies showed that this approach decreases the incidence of new multiple-organ failure as well as the risk of interventional complications. However, the optimal interventional sequence and timing of interventional procedures remain controversial. This review aims to summarize the indications, timing, and treatment outcomes for infected NP and to provide guidance on multidisciplinary decision-making.

• Pancreatitis
• Acute necrotizing pancreatitis
• Necrosis
• Superinfection
• Endoscopy
• Surgery

• Acute Disease
• Drainage/methods
• Endoscopy, Gastrointestinal
• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/therapy

• Acute Disease
• Humans
• Multiple Organ Failure
• Pancreatitis, Acute Necrotizing
• Retrospective Studies
• Severity of Illness Index
• Triglycerides

• Universitat Autònoma de Barcelona

• acute pancreatitis
• computed tomography
• management
• necrotizing pancreatitis
• outcomes
• surgery

• Acute Disease
• Female
• Humans
• Male
• Middle Aged
• Necrosis/complications
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/surgery
• Prospective Studies

Background: Current approaches to predicting intervention needs and mortality have reached 65–85% accuracy, which falls below clinical decision-making requirements in patients with acute pancreatitis (AP). We aimed to accurately predict therapeutic intervention needs and mortality on admission, in AP patients, using machine learning (ML). Methods: Data were obtained from three databases of patients admitted with AP: one retrospective (Chengdu) and two prospective (Liverpool and Chengdu) databases. Intervention and mortality differences, as well as potential predictors, were investigated. Univariate analysis was conducted, followed by a random forest ML algorithm used in multivariate analysis, to identify predictors. The ML performance matrix was applied to evaluate the model’s performance. Results: Three datasets of 2846 patients included 25 potential clinical predictors in the univariate analysis. The top ten identified predictors were obtained by ML models, for predicting interventions and mortality, from the training dataset. The prediction of interventions includes death in non-intervention patients, validated with high accuracy (96%/98%), the area under the receiver-operating-characteristic curve (0.90/0.98), and positive likelihood ratios (22.3/69.8), respectively. The post-test probabilities in the test set were 55.4% and 71.6%, respectively, which were considerably superior to existing prognostic scores. The ML model, for predicting mortality in intervention patients, performed better or equally with prognostic scores. Conclusions: ML, using admission clinical predictors, can accurately predict therapeutic interventions and mortality in patients with AP.

There are few published reports describing the clinical characteristics of acute pancreatitis (AP) patients with multidrug-resistant organism (MDRO) infection.

This was a retrospective analysis of AP patients with MDRO infection in West China Hospital between July 2015 and June 2020. Basic clinical data, disease progression states, and prognoses of the MDRO and non-MDRO infection groups were compared and analyzed. Logistic regression analysis was performed to explore the related risk factors for MDRO infection. The prognoses of different MDRO infection types were compared.

In total, 9812 AP patients were included, 2436 (24.83%) of whom had healthcare-associated infections (641 [26.31%] MDRO infections and 1795 [73.69%] non-MDRO infections). The main MDRO strain was carbapenem-resistant Acinetobacter baumannii (CRAB) (400/62.40%). The rate of discharge against doctor’s advice, mortality, hospitalization expenses, and hospitalization days was higher in the MDRO infection group than in the noninfection group. By logistic regression analysis, the independent risk factors associated with MDRO infection included male sex (OR 1.36, 95% CI 1.09~1.70), severity (OR 1.40, 95% CI 1.10~1.78), ICU referral (OR 2.48, 95% CI 1.79~3.44), abdominal puncture (OR 2.78, 95% CI 1.93~4.02), fiberoptic bronchoscopy (OR 1.95, CI 1.35~2.81), and PICC/CVC placement (OR 1.48, CI 1.06~2.06). Compared with biliary and hypertriglyceridemia (HTG) (OR 0.94, 95% CI 0.73~1.23), alcohol (OR 0.30, 95% CI 0.19~0.47) and other etiologies (OR 0.58, 95% CI 0.41~0.81) conferred a lower risk of MDRO infection. The carbapenem-resistant Klebsiella pneumoniae (CRKP) infection rate was highest in the patients who died.

The CRAB proportion was highest in AP patients with MDRO infection. MDRO infection is related to many factors, has a poor prognosis, and increases the patient burden. CRKP infection is directly related to poor prognosis.

• the Science and Technological Supports Project of Sichuan Province

• infected pancreatic necrosis
• minimally invasive interventions
• pancreas
• transfistulous sequestrectomy

• Humans
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/surgery
• Intraabdominal Infections/etiology
• Endoscopy/adverse effects
• Drainage/adverse effects
• Drainage/methods
• Orthopedic Procedures/adverse effects

• EUS
• LAMS
• acute pancreatitis
• direct endoscopic necrosectomy
• pancreatic necrotic collection
• walled-off pancreatic necrosis

• Acute Disease
• Drainage
• Humans
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Stents
• Treatment Outcome

• Drainage, transgastric
• Endoscopic necrosectomy
• Metal stents, lumen-apposing
• Pancreatic pseudocysts
• Pancreatitis, necrotizing

Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat to hospitalization patients. Infected pancreatic necrosis (IPN) leads to high risks of CRE infections with increasing mortality. Our study aims to determine the predictors related to 90-day overall mortality of CRE IPN.

We retrospectively reviewed the drug resistance rates and clinical characteristics of CRE IPN patients from January 1, 2016, to January 1, 2021. Independent predictors of mortality were identified via univariate and multivariate analyses.

During the 5-year period, 75 IPN patients suffered from 135 episodes of CRE infections with mortality up to 50.7%. CRE strains were highly resistant (> 50%) to nine of ten common antibiotics, except tigecycline (18%). The most common pathogen was carbapenem-resistant Klebsiella pneumoniae (84 of 135). Lung was the main site of extrapancreatic infections, followed by bloodstream and biliary tract. The independent predictors of mortality were Sequential Organ Failure Assessment (SOFA) score > 2 (hazard ratio 3.746, 95% confidence interval 1.209–11.609, P = 0.022) and procalcitonin > 6 ng/l (hazard ratio 2.428, 95% confidence interval 1.204–4.895, P = 0.013).

CRE is widespread as a global challenge with a high mortality rate among IPN patients due to limited therapeutic options. Carbapenem-resistant K. pneumoniae is the leading category of CRE which requires more attention in clinical practice. High SOFA score and procalcitonin level represent two independent predictors of mortality in CRE IPN patients. Greater efforts are needed toward timely therapeutic intervention for CRE IPN.

The online version contains supplementary material available at 10.1007/s40121-021-00489-5.

• Acute pancreatitis
• Carbapenem-resistant Enterobacteriaceae
• Drug resistance
• Infected pancreatic necrosis
• Mortality
• Predictor

• 11883 Cancer Research UK
• A16186 Cancer Research UK
• A17680 Cancer Research UK
• A11883 Cancer Research UK
• 16186 Cancer Research UK
• 16812 Cancer Research UK
• 15957 Cancer Research UK
• 8968 Cancer Research UK
• A16791 Cancer Research UK
• 17680 Cancer Research UK

• acute pancreatitis
• pancreatic disease
• pancreatic pseudocyst

• Severe pancreatitis
• assessment
• guidelines
• surgery

Acute pancreatitis (AP) is defined as an acute inflammatory attack of the pancreas of sudden onset. Around 25% of patients have either moderately severe or severe disease with a mortality rate of 15–20%.

The aim of this article was to summarize the advances being made in the understanding of this disease and the important role of surgery.

An accurate diagnosis should be made a soon as possible, initiating resuscitation with large volume intravenous fluids and oxygen by mask. Predicted severe disease will require intensive monitoring. Most deaths within the first week are due to multi-organ failure; thus, these patients will require intensive therapy unit management. During the second phase of the disease, death is due to local complications arising from the pancreatic inflammation, requiring accurate identification to determine the correct form of treatment. Acute peripancreatic fluid collections arise < 4 weeks after onset of interstitial edematous pancreatitis, not requiring any treatment. Most pancreatic pseudocysts arise > 4 weeks and largely resolve on conservative management. Necrotizing pancreatitis causing acute necrotic collections and later walled-off necrosis will require treatment if symptomatic or infected. Initial endoscopic transgastric or percutaneous drainage will resolve less serious collections but necrosectomy using minimally invasive approaches will be needed for more serious collections. To prevent recurrent attacks of AP, causative factors need to be removed where possible such as cholecystectomy and cessation of alcohol. Future progress requires improved management of multi-organ failure and more effective minimally invasive techniques for the removal of necrosis.

• Endoscopic
• Infection
• Minimally invasive surgery
• Necrosectomy
• Pancreatic necrosis
• Percutaneous

• Acute necrotic collection
• Necrosectomy
• Necrotizing pancreatitis
• Severe acute pancreatitis
• Walled-off necrosis

• Acute Disease
• Cohort Studies
• Drainage
• Humans
• Japan/epidemiology
• Minimally Invasive Surgical Procedures
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Treatment Outcome

• Acute pancreatitis
• Endoscopy
• Necrosectomy
• Randomized controlled trials
• Systematic review

• Drainage/methods
• Endoscopy/adverse effects
• Endoscopy/methods
• Humans
• Intestinal Fistula/etiology
• Pancreatic Fistula/etiology
• Pancreatitis, Acute Necrotizing/surgery
• Randomized Controlled Trials as Topic

• DEN
• Endoscopic necrosectomy
• LAMS
• Necrotizing pancreatitis
• Transmural drainage

Endoscopy and surgery are the two major invasive interventions for necrotizing pancreatitis. However, studies comparing their efficacy and safety are lacking.

To systemically compare the efficacy and safety of endoscopic and surgical interventions for necrotizing pancreatitis.

PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database, and Sino Med were searched to identify all randomized control trials (RCT) and cohort studies comparing the efficacy and safety of endoscopic vs surgical management of necrotizing pancreatitis from January 2000 to June 2019. Revman 5.3 was used for statistical analysis.

A total of eight studies were included, with three RCT and five cohort studies. The total number of patients involved was 366, with 167 in the endoscopy group and 199 in the surgery group. Meta-analysis showed no significant difference between the two groups in clinical remission (odds ratio [OR] = 1.3, 95% confidence interval [CI]: 0.58-2.92, P = 0.52), primary composite endpoint (relative risk [RR] = 0.46, 95%CI: 0.17-1.27, P = 0.14), or mortality (OR = 0.78, 95%CI: 0.37-1.56, P = 0.52). Compared to surgery, endoscopic therapy significantly reduced the rates of postoperative complications including new-onset organ failure (OR = 0.40, 95%CI: 0.18-0.90, P = 0.03), enterocutaneous fistula or perforation of a visceral organ (OR = 0.46, 95%CI: 0.23-0.91, P = 0.02), and pancreatic fistula (OR = 0.09, 95%CI: 0.03-0.24, P < 0.00001).

Endoscopic treatment, as compared to surgery, significantly reduces complications in patients with necrotizing pancreatitis.

• Necrotizing pancreatitis
• Endoscopy
• Surgery
• Meta-analysis

• Acute pancreatitis
• Endoscopic
• Mortality
• Necrosectomy
• Open surgery
• Percutaneous

• Aged
• Data Analysis
• Databases, Factual
• Debridement/methods
• Debridement/mortality
• Drainage/methods
• Drainage/mortality
• Endoscopy, Digestive System/methods
• Endoscopy, Digestive System/mortality
• Female
• Humans
• Male
• Middle Aged
• Pancreas/surgery
• Pancreatectomy/methods
• Pancreatectomy/mortality
• Pancreatitis/mortality
• Pancreatitis/surgery
• Pancreatitis, Acute Necrotizing/mortality
• Pancreatitis, Acute Necrotizing/surgery
• Retrospective Studies
• Risk Factors
• Treatment Outcome

• Acute pancreatitis
• Infected pancreatic necrosis
• Mortality
• Necrosectomy
• Open necrosectomy
• Organ failure
• Pancreatic necrosis
• Pancreatitis
• Severe acute pancreatitis
• Walled-off necrosis

• Cystogastrostomy
• Endoscopic
• Laparoscopic
• Pancreatic fluid collections
• Pseudocyst
• Walled off necrosis

• Adolescent
• Adult
• Aged
• Drainage/methods
• Endoscopy, Digestive System
• Female
• Humans
• Laparoscopy
• Male
• Middle Aged
• Necrosis/etiology
• Necrosis/therapy
• Pancreas/pathology
• Pancreatic Juice
• Pancreatic Pseudocyst/etiology
• Pancreatic Pseudocyst/surgery
• Pancreatic Pseudocyst/therapy
• Pancreatitis/complications
• Postoperative Complications
• Young Adult

Infected necrotizing pancreatitis is a challenging condition to treat because of the profound inflammatory response these patients undergo which can then be exacerbated by interventions. Treatment of this condition has evolved in timing of intervention as well as method of intervention and includes less invasive options for treatment such as percutaneous drainage and endoscopic drainage, in addition to less invasive endoscopic and video-assisted or laparoscopic debridements. The precise optimal treatment strategy for these patients is an ongoing topic of discussion and may be different for each patient as this is a heterogenous condition.

• acute pancreatitis
• pancreas
• pancreatitis
• severe acute pancreatitis

• Drainage
• Endoscopic ultrasound intervention
• Metal stents
• Pancreatic fluid collection
• Pancreatic pseudocyst
• Plastic stents

• Aged
• Drainage/adverse effects
• Drainage/instrumentation
• Female
• Hemorrhage/etiology
• Humans
• Male
• Middle Aged
• Odds Ratio
• Pancreas/surgery
• Pancreatic Juice
• Plastics
• Self Expandable Metallic Stents/adverse effects
• Stents/adverse effects
• Treatment Outcome

• 08/29/02 Department of Health
• 15957 Cancer Research UK
• EME/15/20/01 Department of Health
• PB-PG-0407-13363 Department of Health

• Acute pancreatitis
• Fluid collection
• Management
• Minimally invasive procedure
• Surgery