Tags

Type your tag names separated by a space and hit enter

Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines.
Endoscopy 2018; 50(5):524-546E

Abstract

1: ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2: ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3: ESGE recommends initial goal-directed intravenous fluid therapy with Ringer's lactate (e. g. 5 - 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4: ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5: ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6: ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7: ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8: ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence.

Authors+Show Affiliations

Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium.Gedyt Endoscopy Center, Buenos Aires, Argentina.Robert-Bosch-Krankenhaus, Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Stuttgart, Germany.Department of Gastroenterology and Hepatology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium.Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium.Service d'Hépato-gastroentérologie, Hôpital Nord, Marseille, France.Department of Surgery, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium.Gastroenterology Unit, Department of Surgery, Hospital Beatriz Ângelo, Loures, Portugal.Dept. of Gastroenterology, Medical Centre Hungarian Defense Forces, Budapest, Hungary.Semmelweis University, 1st Department of Surgery, Endoscopy Unit, Budapest, Hungary.Department of Gastroenterology and Hepatology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.Service de Gastroentérologie et Hépatologie, Hôpital Desgenettes, Lyon, France.Hepatogastroenterology Unit, Second Department of Internal Medicine, Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece.Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.Gastroenterologie, Klinik Hirslanden, Zurich, Switzerland.Centre Hospitalier Universitaire de Nice, Pole D.A.R.E, Endoscopie Digestive, Nice, France.Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.Department of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands and Department of Surgical Oncology, University Medical Center Utrecht Cancer Center, The Netherlands.Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital Université Libre de Bruxelles, Brussels, Belgium.Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

29631305

Citation

Arvanitakis, Marianna, et al. "Endoscopic Management of Acute Necrotizing Pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Evidence-based Multidisciplinary Guidelines." Endoscopy, vol. 50, no. 5, 2018, pp. 524-546.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50(5):524-546.
Arvanitakis, M., Dumonceau, J. M., Albert, J., Badaoui, A., Bali, M. A., Barthet, M., ... van Hooft, J. (2018). Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy, 50(5), pp. 524-546. doi:10.1055/a-0588-5365.
Arvanitakis M, et al. Endoscopic Management of Acute Necrotizing Pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Evidence-based Multidisciplinary Guidelines. Endoscopy. 2018;50(5):524-546. PubMed PMID: 29631305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. AU - Arvanitakis,Marianna, AU - Dumonceau,Jean-Marc, AU - Albert,Jörg, AU - Badaoui,Abdenor, AU - Bali,Maria Antonietta, AU - Barthet,Marc, AU - Besselink,Marc, AU - Deviere,Jacques, AU - Oliveira Ferreira,Alexandre, AU - Gyökeres,Tibor, AU - Hritz,Istvan, AU - Hucl,Tomas, AU - Milashka,Marianna, AU - Papanikolaou,Ioannis S, AU - Poley,Jan-Werner, AU - Seewald,Stefan, AU - Vanbiervliet,Geoffroy, AU - van Lienden,Krijn, AU - van Santvoort,Hjalmar, AU - Voermans,Rogier, AU - Delhaye,Myriam, AU - van Hooft,Jeanin, Y1 - 2018/04/09/ PY - 2018/4/10/pubmed PY - 2019/4/4/medline PY - 2018/4/10/entrez SP - 524 EP - 546 JF - Endoscopy JO - Endoscopy VL - 50 IS - 5 N2 - 1: ESGE suggests using contrast-enhanced computed tomography (CT) as the first-line imaging modality on admission when indicated and up to the 4th week from onset in the absence of contraindications. Magnetic resonance imaging (MRI) may be used instead of CT in patients with contraindications to contrast-enhanced CT, and after the 4th week from onset when invasive intervention is considered because the contents (liquid vs. solid) of pancreatic collections are better characterized by MRI and evaluation of pancreatic duct integrity is possible. Weak recommendation, low quality evidence. 2: ESGE recommends against routine percutaneous fine needle aspiration (FNA) of (peri)pancreatic collections. Strong recommendation, moderate quality evidence. FNA should be performed only if there is suspicion of infection and clinical/imaging signs are unclear. Weak recommendation, low quality evidence. 3: ESGE recommends initial goal-directed intravenous fluid therapy with Ringer's lactate (e. g. 5 - 10 mL/kg/h) at onset. Fluid requirements should be patient-tailored and reassessed at frequent intervals. Strong recommendation, moderate quality evidence. 4: ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Strong recommendation, high quality evidence. 5: ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis and clinically suspected or proven infected necrosis. Strong recommendation, low quality evidence.ESGE suggests that the first intervention for infected necrosis should be delayed for 4 weeks if tolerated by the patient. Weak recommendation, low quality evidence. 6: ESGE recommends performing endoscopic or percutaneous drainage of (suspected) infected walled-off necrosis as the first interventional method, taking into account the location of the walled-off necrosis and local expertise. Strong recommendation, moderate quality evidence. 7: ESGE suggests that, in the absence of improvement following endoscopic transmural drainage of walled-off necrosis, endoscopic necrosectomy or minimally invasive surgery (if percutaneous drainage has already been performed) is to be preferred over open surgery as the next therapeutic step, taking into account the location of the walled-off necrosis and local expertise. Weak recommendation, low quality evidence. 8: ESGE recommends long-term indwelling of transluminal plastic stents in patients with disconnected pancreatic duct syndrome. Strong recommendation, low quality evidence. Lumen-apposing metal stents should be retrieved within 4 weeks to avoid stent-related adverse effects.Strong recommendation, low quality evidence. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/29631305/Endoscopic_management_of_acute_necrotizing_pancreatitis:_European_Society_of_Gastrointestinal_Endoscopy__ESGE__evidence_based_multidisciplinary_guidelines_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/a-0588-5365 DB - PRIME DP - Unbound Medicine ER -