Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study.

van Grinsven, Janneke; van Brunschot, Sandra; Bakker, Olaf J; Bollen, Thomas L; Boermeester, Marja A; Bruno, Marco J; Dejong, Cornelis H; Dijkgraaf, Marcel G; van Eijck, Casper H; Fockens, Paul; van Goor, Harry; Gooszen, Hein G; Horvath, Karen D; van Lienden, Krijn P; van Santvoort, Hjalmar C; Besselink, Marc G; Dutch Pancreatitis Study Group; Abdelhafez, M; Andersson, R; Andren-Sandberg, A; Ashley, S; van Baal, M; Baron, T; Bassi, C; Bradley, E; Buchler, M; Cappendijk, V; Carter, R; Charnley, R; Coelho, D; Connor, S; Dellinger, P; Dervenis, C; Deviere, J; Doctor, N; Dudeja, V; En-Qiang, M; Escourrou, J; Fagenholz, P; Farkas, G; Forsmark, C; Freeman, M; Freeny, P; French, J; Friess, H; Gardner, T; Goetzinger, P; Haveman, J; Hofker, S; Imrie, C; Isaji, S; Isenmann, R; Klar, E; Laméris, J; Lerch, M; Lévy, P; Lillemoe, K; Löhr, M; Mayerle, J; Mayumi, T; Mittal, A; Moessner, J; Morgan, D; Mortele, K; Nealon, W; Neoptolemos, J; Nieuwenhuijs, V; Nordback, I; Olah, A; Oppong, K; Padbury, R; Papachristou, G; Parks, R; Poley, J; Radenkovic, D; Raraty, M; Rau, B; Rebours, V; Rische, S; Runzi, M; Sainani, N; Sarr, M; Schaapherder, S; Seewald, S; Seifert, H; Shimosegawa, T; Silverman, S; Singh, V; Siriwardena, A; Steinberg, W; Sutton, R; Takeda, K; Timmer, R; Vege, S; Voermans, R; de Waele, J; Wang, Ch; Warshaw, A; Werner, J; Weusten, B; Whitcomb, D; Wig, J; Windsor, J; Zyromski, N     «

van Grinsven, Janneke; van Brunschot, Sandra; Bakker, Olaf J; Bollen, Thomas L; Boermeester, Marja A; Bruno, Marco J; Dejong, Cornelis H; Dijkgraaf, Marcel G; van Eijck, Casper H; Fockens, Paul; van Goor, Harry; Gooszen, Hein G; Horvath, Karen D; van Lienden, Krijn P; van Santvoort, Hjalmar C; Besselink, Marc G; Dutch Pancreatitis Study Group; Abdelhafez, M; Andersson, R; Andren-Sandberg, A; Ashley, S; van Baal, M; Baron, T; Bassi, C; Bradley, E; Buchler, M; Cappendijk, V; Carter, R; Charnley, R...     »

The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis are subject to debate. A survey was performed on these topics amongst a group of international expert pancreatologists.An online survey including case vignettes was sent to 118 international pancreatologists. The use and timing of fine-needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy were evaluated.The response rate was 74% (N = 87). None of the respondents use FNA routinely, 85% selectively and 15% never. Most respondents (87%) use a step-up approach in patients with infected necrosis. Walled-off necrosis (WON) is considered a prerequisite for endoscopic drainage and percutaneous drainage by 66% and 12%, respectively. After diagnosing infected necrosis, 55% routinely postpone invasive interventions, whereas 45% proceed immediately to intervention. A lack of consensus about timing of intervention was apparent on day 14 with proven infected necrosis (58% intervention versus 42% non-invasive) as well as on day 20 with only clinically suspected infected necrosis (59% intervention versus 41% non-invasive).The step-up approach is the preferred treatment strategy in infected necrotizing pancreatitis amongst expert pancreatologists. There is no uniformity regarding the use of FNA and timing of intervention in the first 2-3 weeks of infected necrotizing pancreatitis.     «

The optimal diagnostic strategy and timing of intervention in infected necrotizing pancreatitis are subject to debate. A survey was performed on these topics amongst a group of international expert pancreatologists.An online survey including case vignettes was sent to 118 international pancreatologists. The use and timing of fine-needle aspiration (FNA), antibiotics, catheter drainage and (minimally invasive) necrosectomy were evaluated.The response rate was 74% (N = 87). None of the respondents...     »