Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6335
Peer-review started: April 18, 2016
First decision: May 12, 2016
Revised: May 22, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 28, 2016
Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrast-enhanced computed tomography. By univariate analysis, all of the 9 prognostic factors were associated with AP-related death. A multivariate analysis identified 4 out of the 9 prognostic factors (base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age) that were associated with AP-related death. Receiver-operating characteristics curve analysis showed that the area under the curve was 0.82 for these 4 prognostic factors and 0.84 for the 9 prognostic factors, suggesting the comparable utility of these 4 factors in the severity assessment. We also examined the temporal changes in treatment strategy for walled-off necrosis in Japan according to the 2003, 2007, and 2011 surveys. Step-up approaches and less-invasive endoscopic therapies were uncommon in 2003 and 2007, but became popular in 2011. Mortality has been decreasing in patients who require intervention for walled-off necrosis. In conclusion, the nationwide survey revealed the comparable utility of 4 prognostic factors in the severity assessment and the increased use of less-invasive, step-up approaches with improved clinical outcomes in the management of walled-off necrosis.
Core tip: We analyzed the results of nationwide epidemiological surveys of acute pancreatitis in Japan to clarify the utility of the prognostic factor scores in the severity assessment and the trend in the treatment of walled-off necrosis. Among the 9 prognostic factors, 4 factors including base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age were associated with mortality by multivariate analysis. Receiver operating characteristics curve analysis demonstrated the comparable utility of these 4 factors to the 9 factors in the severity assessment. Less-invasive, step-up approaches with improved clinical outcomes have become popular in the management of walled-off necrosis.