Featured Research

from universities, journals, and other organizations

Less invasive techniques help manage complications of severe pancreatic disease

Date:
January 11, 2011
Source:
American Gastroenterological Association
Summary:
The use of combined treatments for severe acute pancreatitis is safe and effective in managing the disease, resulting in shorter hospitalizations and fewer radiological procedures than standard therapy, according to a new study. In a related study, doctors found that patients with infected pancreatic necrosis were able to avoid surgery through primary conservative treatment, which is in-patient medical treatment.

The use of combined treatments for severe acute pancreatitis is safe and effective in managing the disease, resulting in shorter hospitalizations and fewer radiological procedures than standard therapy, according to a study in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute. In a related study, doctors found that patients with infected pancreatic necrosis were able to avoid surgery through primary conservative treatment, which is in-patient medical treatment.

Pancreatitis refers to the inflammation of the pancreas that usually begins as a sudden attack and is often caused by gallstones or alcohol abuse. Severe acute pancreatitis is the initial stage of pancreatitis, characterized by gradual or sudden severe pain in the center part of the abdomen that moves around to the back, signaling a damaged or severely irritated pancreas. Some people have more than one attack and recover completely after each episode, yet 20 percent of patients with acute pancreatitis have a severe, life-threatening illness with multiple complications, including walled-off pancreatic necrosis (WOPN). WOPN can become infected, obstruct or create passages to adjacent organs, erode into or compress blood vessels, and significantly delay a patient's functional improvement. When WOPN becomes infected or obstructs nearby organs, drainage and surgery generally has been advocated. However, less invasive techniques have evolved over the past 15 years that show equivalent effectiveness and fewer complications than surgery.

Doctors at Virginia Mason Medical Center compared the established treatment for WOPN (standard percutaneous drainage, which uses a thin needle to drain the infected fluid) with combined modality therapy (endoscopic transenteric [through the intestine] stents added to a regimen of percutaneous [under the skin] drains). Symptomatic patients with WOPN between January 2006 and August 2009 were treated with standard percutaneous drainage or combined modality therapy and compared by disease severity, length of hospitalization, duration of drainage, complications, and number of radiological and endoscopic procedures.

Patients undergoing combined modality therapy had significantly decreased length of hospitalization, duration of external drainage and number of computed tomography scans. Patients in the standard percutaneous drainage group had more complications.

"Patients with walled-off pancreatic necrosis require long hospitalization, utilize substantial amounts of health-care resources and are exposed to large quantities of ionizing radiation," said Michael Gluck, MD, of the Digestive Disease Institute, Virginia Mason Medical Center, and lead author of the study. "Until a large, multi-center, randomized trial is conducted, this current study adds another seemingly effective and safe management technique for symptomatic walled-off pancreatic necrosis with the added benefit of reducing length of hospitalization and use of radiological resources."

A life-threatening complication of acute pancreatitis is infected pancreatic necrosis (dead pancreatic tissue), which accounts for the majority of deaths in patients with acute pancreatitis. According to various practice guidelines, the standard of care for necrotizing pancreatitis is surgery. In a second study, doctors compared the outcomes of surgical treatment versus primary conservative treatment, in which patients are kept in intensive care and treated with antibiotics, organ support, intensive nutritional support and, if required, percutaneous drainage.

"Until now, there has not been a trial comparing conservative and surgical therapy in patients with infected pancreatitis necrosis because conservative management was never considered a viable treatment option," said Pramod Kumar Garg, MD, DM, of the All India Institute of Medical Sciences, New Delhi, and lead author of this study. "We were able to demonstrate that throughout the course of 10 years, those who received primary conservative treatment had significantly higher survival rates than those who underwent surgery."

A group of 28 patients with infected pancreatitis necrosis were treated with surgery, while 52 patients in a second group were given primary conservative treatment. A primary conservative strategy resulted in mortality that was comparable with that following surgery. In addition, 76 percent of the patients were able to avoid surgery, and 54.5 percent were successfully managed with the primary conservative strategy.


Story Source:

The above story is based on materials provided by American Gastroenterological Association. Note: Materials may be edited for content and length.


Journal References:

  1. Michael Gluck, Andrew Ross, Shayan Irani, Otto Lin, Ellen Hauptmann, Justin Siegal, Mehran Fotoohi, Robert Crane, David Robinson, Richard A. Kozarek. Endoscopic and Percutaneous Drainage of Symptomatic Walled-Off Pancreatic Necrosis Reduces Hospital Stay and Radiographic Resources. Clinical Gastroenterology and Hepatology, 2010; 8 (12): 1083 DOI: 10.1016/j.cgh.2010.09.010
  2. Pramod Kumar Garg, Manik Sharma, Kaushal Madan, Peush Sahni, Debabrata Banerjee, Rohit Goyal. Primary Conservative Treatment Results in Mortality Comparable to Surgery in Patients With Infected Pancreatic Necrosis. Clinical Gastroenterology and Hepatology, 2010; 8 (12): 1089 DOI: 10.1016/j.cgh.2010.04.011

Cite This Page:

American Gastroenterological Association. "Less invasive techniques help manage complications of severe pancreatic disease." ScienceDaily. ScienceDaily, 11 January 2011. <www.sciencedaily.com/releases/2011/01/110106100938.htm>.
American Gastroenterological Association. (2011, January 11). Less invasive techniques help manage complications of severe pancreatic disease. ScienceDaily. Retrieved September 17, 2014 from www.sciencedaily.com/releases/2011/01/110106100938.htm
American Gastroenterological Association. "Less invasive techniques help manage complications of severe pancreatic disease." ScienceDaily. www.sciencedaily.com/releases/2011/01/110106100938.htm (accessed September 17, 2014).

Share This



More Health & Medicine News

Wednesday, September 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Obama Orders Military Response to Ebola

Obama Orders Military Response to Ebola

AP (Sep. 16, 2014) Calling the Ebola outbreak in West Africa a potential threat to global security, President Barack Obama is ordering 3,000 U.S. military personnel to the stricken region amid worries that the outbreak is spiraling out of control. (Sept. 16) Video provided by AP
Powered by NewsLook.com
UN: 20,000 Could Be Infected With Ebola by Year End

UN: 20,000 Could Be Infected With Ebola by Year End

AFP (Sep. 16, 2014) Nearly $1.0 billion dollars is needed to fight the Ebola outbreak raging in west Africa, the United Nations say, warning that 20,000 could be infected by year end. Duration: 00:40 Video provided by AFP
Powered by NewsLook.com
Obama: Ebola Outbreak Threat to Global Security

Obama: Ebola Outbreak Threat to Global Security

AP (Sep. 16, 2014) President Obama is ordering U.S. military personnel to West Africa to deal with the Ebola outbreak, which is he calls a potential threat to global security. (Sept. 16) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

    Technology News



    Save/Print:
    Share:

    Free Subscriptions


    Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

    Get Social & Mobile


    Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

    Have Feedback?


    Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
    Mobile: iPhone Android Web
    Follow: Facebook Twitter Google+
    Subscribe: RSS Feeds Email Newsletters
    Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins