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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(02): 081-086
DOI: 10.1055/s-0042-1751035
Original Article

Feasibility and Safety of Bedside Percutaneous Catheter Drainage of Necrotic Pancreatic Fluid Collections in the Intensive Care Unit

Pankaj Gupta 
1   Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Shreya Sehgal
1   Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Jyoti Gupta
1   Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Jayanta Samanta
2   Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Harshal Mandavdhare
2   Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vishal Sharma
2   Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Usha Dutta
2   Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rakesh Kochhar
2   Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Manavjit Singh Sandhu
1   Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract

Purpose Critically ill patients with acute pancreatitis (AP) require intensive care unit (ICU) admission. The management of pancreatic fluid collections (PFCs) in this group is challenging. We aimed to evaluate the feasibility and safety of bedside percutaneous ultrasound (USG)-guided interventions in necrotic PFC in ICU patients.

Methods This retrospective study comprised consecutive patients with AP in the ICU who underwent bedside USG-guided interventions for necrotic PFC. Indications for intervention, technical success, clinical success, and complications were recorded. The site, number, and size of catheters were recorded. Clinical outcomes were assessed.

Results Thirty-three patients (mean age, 38.1 years, 15 females) were included. All patients had nonresolving organ failure and were on mechanical ventilation. The mean pain to percutaneous catheter drainage (PCD interval was 42.2 days (range, 7–167 days). All the procedures were technically successful, and none of the patients required shifting to the interventional radiology suite for computed tomography guidance. PCD was clinically successful in 40% of the patients. There were no major complications. The mean length of hospital stay and ICU stay was 35 days (range, 6–69 days) and 13 days (range, 1–63 days), respectively. Six (17.1%) patients underwent necrosectomy. Sixteen (45.7%) patients died in the hospital.

Conclusion USG-guided bedside PCD can be performed safely with high technical success in the ICU setting.

Keywords

drainage - collections - catheter - acute necrotizing pancreatitis - ultrasound

Ethical Approval

This was a retrospective study performed at a tertiary care referral center, where a large number of patients with AP are managed. The study was approved by the local ethics committee.




Publication History

Article published online:
02 July 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 van Santvoort HC, Besselink MG, Bakker OJ. et al; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362 (16) 1491-1502
    CrossrefPubMedGoogle Scholar
  • 2 Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology 2019; 156 (07) 1994-2007.e3
    CrossrefPubMedGoogle Scholar
  • 3 Gupta P, Rana P, Bellam BL. et al. Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis. Pancreatology 2020; 20 (01) 9-15
    CrossrefPubMedGoogle Scholar
  • 4 Gupta P, Dawra S, Chandel K. et al. Fat-modified computed tomography severity index (CTSI) is a better predictor of severity and outcome in patients with acute pancreatitis compared with modified CTSI. Abdom Radiol (NY) 2020; 45 (05) 1350-1358
    CrossrefPubMedGoogle Scholar
  • 5 van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG. Dutch Pancreatitis Study Group. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011; 98 (01) 18-27
    CrossrefPubMedGoogle Scholar
  • 6 Ke L, Li J, Hu P, Wang L, Chen H, Zhu Y. Percutaneous catheter drainage in infected pancreatitis necrosis: a systematic review. Indian J Surg 2016; 78 (03) 221-228
    CrossrefPubMedGoogle Scholar
  • 7 Zhang ZH, Ding YX, Wu YD, Gao CC, Li F. A meta-analysis and systematic review of percutaneous catheter drainage in treating infected pancreatitis necrosis. Medicine (Baltimore) 2018; 97 (47) e12999
    CrossrefPubMedGoogle Scholar
  • 8 Bellam BL, Samanta J, Gupta P. et al. Predictors of outcome of percutaneous catheter drainage in patients with acute pancreatitis having acute fluid collection and development of a predictive model. Pancreatology 2019; 19 (05) 658-664
    CrossrefPubMedGoogle Scholar
  • 9 Mortelé K-J, Girshman J, Szejnfeld D. et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol 2009; 192 (01) 110-116
    CrossrefPubMedGoogle Scholar
  • 10 Mallick B, Dhaka N, Gupta P. et al. An audit of percutaneous drainage for acute necrotic collections and walled off necrosis in patients with acute pancreatitis. Pancreatology 2018; 18 (07) 727-733
    CrossrefPubMedGoogle Scholar
  • 11 Gupta P, Gupta J, Kumar C. et al. Aggressive percutaneous catheter drainage protocol for necrotic pancreatic collections. Dig Dis Sci 2020; 65 (12) 3696-3701
    CrossrefPubMedGoogle Scholar
  • 12 Gupta P, Koshi S, Samanta J. et al. Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis. Exp Ther Med 2020; 20 (03) 2311-2316
    PubMedGoogle Scholar
  • 13 Wroński M, Cebulski W, Karkocha D. et al. Ultrasound-guided percutaneous drainage of infected pancreatic necrosis. Surg Endosc 2013; 27 (08) 2841-2848
    CrossrefPubMedGoogle Scholar
  • 14 Navalho M, Pires F, Duarte A, Gonçalves A, Alexandrino P, Távora I. Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging 2006; 30 (02) 114-119
    CrossrefPubMedGoogle Scholar
  • 15 Ai XB, Qian XP, Pan WS. et al. Ultrasound-guided percutaneous catheter drainage in early treatment of severe acute pancreatitis. World J Emerg Med 2010; 1 (01) 45-48
    PubMedGoogle Scholar
  • 16 Delattre JF, Levy Chazal N, Lubrano D, Flament J-B. Percutaneous ultrasound-guided drainage in the surgical treatment of acute severe pancreatitis [in French]. Ann Chir 2004; 129 (09) 497-502
    PubMedGoogle Scholar
  • 17 Jong NH, Rim S, Kim H-S. et al. Role of ultrasound-guided percutaneous catheter drainage in the management of infected pancreatic necrosis. Archives of Internal Medicine Research 2019; 2: 61-69
    PubMedGoogle Scholar
  • 18 Guo Q, Li A, Hu W. Predictive factors for successful ultrasound-guided percutaneous drainage in necrotizing pancreatitis. Surg Endosc 2016; 30 (07) 2929-2934
    CrossrefPubMedGoogle Scholar
  • 19 Bansal A, Gupta P, Singh H. et al. Gastrointestinal complications in acute and chronic pancreatitis. JGH Open 2019; 3 (06) 450-455
    CrossrefPubMedGoogle Scholar
  • 20 Gupta P, Chayan Das G, Sharma V. et al. Role of computed tomography in prediction of gastrointestinal fistula in patients with acute pancreatitis. Acta Gastroenterol Belg 2019; 82 (04) 495-500
    PubMedGoogle Scholar
  • 21 Verma N, Maurya M, Gupta P. et al. Retroperitoneal versus transperitoneal percutaneous catheter drainage of necrotic pancreatic collections: a comparative analysis. Abdom Radiol (NY) 2022; 47 (05) 1899-1906
    CrossrefPubMedGoogle Scholar
  • 22 Sugimoto M, Sonntag DP, Flint GS. et al. Better outcomes if percutaneous drainage is used early and proactively in the course of necrotizing pancreatitis. J Vasc Interv Radiol 2016; 27 (03) 418-425
    CrossrefPubMedGoogle Scholar
  • 23 Mukund A, Singla N, Bhatia V, Arora A, Patidar Y, Sarin SK. Safety and efficacy of early image-guided percutaneous interventions in acute severe necrotizing pancreatitis: a single-center retrospective study. Indian J Gastroenterol 2019; 38 (06) 480-487
    CrossrefPubMedGoogle Scholar