Zurück

ID: 366 (Conflict of Interest: K)

Niedrige Mortalitätsrate durch einen Step Up Approach in der Behandlung der akuten Pankreatitis - Single Center Erfahrungsbericht bei 302 Patienten

H.Wundsam, F.Bräuer, C.Schwaiger, G.Spaun, R.Függer
Ordensklinikum Linz Barmherzige Schwestern, Linz

Einleitung

Management of acute pancreatitis has changed significantly over the last decades. The step up approach using either flexible endoscopy or a minimal invasive retroperitoneal access has reduced mortality and morbidity in patients with acute necrotising pancreatitis. For the endoscopic approach, the use of self expending covered metal stents facilitates necrosectomy and drainage of walled off necrosis (WON).

Material und Methoden

From 01/2014 to 07/2017 a total number of 302 patients with acute pancreatitis have been treated in our institution. We retrospectively analysed the data of these patients. Mortality and morbidity, interventions, complications and new onset of diabetes have been recorded. The evolution of endoscopic necrosectomy from initial balloon dilatation and plastic stents as well as self expanding metal stents to the use of lumen opposing fully covered metal stents with internal plastic double pigtail drainage is described.

Ergebnisse

Out of 302 patients treated with acute pancreatitis 30,8% (93 pat.) developed pancreatic fluid collection.

41,9% (39/93) of these resolved spontaneously and 58,1% (54/93) needed intervention.

36,5% (34/93) were treated endoscopically: 11,8% (11/93) received double pigtail drainage. 24,7 % (23/93) were treated with an endoscopic metal stent. 5,4% (5/93) needed retroperitoneal surgical necrosectomy alone, 2,2% (2/93) received only radiological drainage. 14% (13/93) were treated radiologically a/o endoscopically a/o surgically.

Overall 90-days-mortality rate was 3,70%, 1-year-mortality rate was 5,6%. Stent related bleeding occurred in 7,4%.

No transperitoneal necrosectomy was needed.

Schlussfolgerung

Treating acute pancreatitis with a step up approach including stent in stent procedures leads to low mortalitiy rates and low stent associated bleeding complications. Moreover it helps to minimize the necessity for open transperitoneal surgical necrosectomy.