Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta-analysis

被引：25

作者：

Nakai, Yousuke ^{[1
,2
]}

Shiomi, Hideyuki ^{[3
]}

Hamada, Tsuyoshi ^{[1
,4
]}

Ota, Shogo ^{[3
]}

Takenaka, Mamoru ^{[5
]}

Iwashita, Takuji ^{[6
]}

Sato, Tatsuya ^{[1
]}

Saito, Tomotaka ^{[1
]}

Masuda, Atsuhiro ^{[7
]}

Matsubara, Saburo ^{[8
]}

Iwata, Keisuke ^{[9
]}

Mukai, Tsuyoshi ^{[10
]}

Isayama, Hiroyuki ^{[11
]}

Yasuda, Ichiro ^{[12
]}

机构：

[1] Univ Tokyo, Dept Gastroenterol, Grad Sch Med, Tokyo, Japan

[2] Univ Tokyo Hosp, Dept Endoscopy & Endoscop Surg, 7-3-1 Hongo Bunkyo ku, Tokyo 1138655, Japan

[3] Hyogo Med Univ, Div Gastroenterol & Hepatobiliary & Pancreat Dis, Dept Internal Med, Nishinomiya, Hyogo, Japan

[4] Canc Inst Hosp Japanese Fdn Canc Res, Dept Hepatobiliary Pancreat Med, Tokyo, Japan

[5] Kindai Univ, Dept Gastroenterol & Hepatol, Fac Med, Osaka, Japan

[6] Gifu Univ Hosp, Dept Internal Med 1, Gifu, Japan

[7] Kobe Univ, Grad Sch Med, Dept Internal Med, Div Gastroenterol, Kobe, Hyogo, Japan

[8] Saitama Med Univ, Dept Gastroenterol & Hepatol, Saitama Med Ctr, Saitama, Japan

[9] Gifu Municipal Hosp, Dept Gastroenterol, Gifu, Japan

[10] Kanazawa Med Univ, Dept Gastroenterol Endoscopy, Kanazawa, Ishikawa, Japan

[11] Juntendo Univ, Dept Gastroenterol, Grad Sch Med, Tokyo, Japan

[12] Toyama Univ, Dept Internal Med 3, Toyama, Japan

来源：

DEN OPEN | 2023年 / 3卷 / 01期

关键词：

acute necrotizing pancreatitis; drainage; endoscopic ultrasound; necrosectomy; walled-off necrosis; PERCUTANEOUS CATHETER DRAINAGE; MANAGEMENT;

D O I：

10.1002/deo2.171

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objectives: Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta-analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut-off defined in the revised Atlanta classification (<= 4 vs. >4 weeks). Methods: Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random-effects model. Results: We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66-3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21-2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15-1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. Conclusions: Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies.

引用

页数：12

共 49 条

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