Comments on the article about correlation between computerized tomography and surgery in acute pancreatitis

Abstract

We read with great interest the article by Vege et al published in issue 34 of World J Gastroenterol 2010. The article evaluates the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic collections found at surgery. The results of their study indicate that most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue and CECT has a limited role in differentiating various types of collections. However, there are some points that need to be addressed, including data about the stage of acute pancreatitis in which CECT was done and the time span between CECT examination and surgery.

Key Words: Acute pancreatitis, Pancreatic necrosis, Peripancreatic fluid collection, Contrast-enhanced computerized tomography, Surgery

TO THE EDITOR

We read with great interest the article by Vege et al[1] published in issue 34 of World J Gastroenterol 2010. The article evaluates the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic collections found at surgery. For that purpose the authors excluded false positive and negative collections found on CT and presented their results in a comparative analysis. The results of their study indicate that most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue and CECT has a limited role in differentiating the different types of collections.

However, there are some points that need to be addressed. The authors neither specified in which stage of acute pancreatitis (pro-inflammatory or anti-inflammatory response) was CECT done nor they specified the time span between CECT examination and surgery. Since the clinical course of severe acute pancreatitis is very dynamic, and CECT and surgery were not performed concurrently, it may not be the matter of false negative and positive findings, but the collections could have rather be formed or disappeared in between CECT examination and surgery. Furthermore, the collections could have progressed from one stage to another, e.g. from necrotic to necrotic with pus or to liquefaction (as identified at surgery), which could have also introduced significant bias into the analysis. We believe that this is a serious methodological limitation to this study which deserves attention, apart from having a significant number of unidentified collections with fluid but without necrosis on CECT.

By the way, the authors erroneously specified at the end of the 2nd paragraph in the Results section under the subheading Peripancreatic collections that 5 of 9 unidentified collections on CECT had associated necrosis and 4 had only fluid without necrosis, whereas it is obvious from Figure 1 that 4 collections had associated necrosis and 5 had no associated necrosis.