Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review
Leilei Zhu1,2, Jingyi Shen3, Rongrong Fu4
1Emergency Department, Ningbo No. 2 Hospital, Ningbo, China.
Background:
Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP.
Methods:
Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications.
Results:
Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention.
Conclusions:
Early intervention is safe and recommended only for patients with indications for intervention, such as infection.
Insights
Early minimally invasive intervention (MII) for acute necrotizing pancreatitis (ANP) shows no difference in mortality compared to delayed MII. Early intervention is safe for ANP patients with specific indications like infection.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Critical Care Medicine
Background:
- Acute necrotizing pancreatitis (ANP) management has shifted towards minimally invasive intervention (MII).
- Optimal timing for MII in ANP remains a critical clinical question.
- This study evaluates early versus delayed MII in ANP patients.
Approach:
- Systematic literature search across major databases (PubMed, Embase, Cochrane, Web of Science) up to June 2022.
- Included nine studies involving 870 patients undergoing MII for ANP.
- Primary outcome: mortality. Secondary outcomes: various complications.
Key Points:
- No significant difference in mortality between early and delayed MII groups.
- MII timing did not impact rates of respiratory, cardiovascular, renal failure, or multiple organ failure.
- No association found with gastrointestinal/pancreatic fistulas, stent migration, bleeding, thrombosis, or endocrine insufficiency.
Conclusions:
- Early MII for ANP is safe.
- Early intervention is recommended for ANP patients presenting with clear indications, such as infection.
- Subgroup analysis indicated a higher risk of renal failure with early intervention in biliary and Asian ANP patients.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include: