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Zeng Y, Zhang JW, Yang J. Endoscopic management of infected necrotizing pancreatitis: Advancing through standardization. World J Gastroenterol 2025; 31:107451. [DOI: 10.3748/wjg.v31.i20.107451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Revised: 04/12/2025] [Accepted: 05/12/2025] [Indexed: 05/28/2025] Open
Abstract
Infected necrotizing pancreatitis (INP) remains a life-threatening complication of acute pancreatitis. Despite advancements such as endoscopic ultrasound (EUS)-guided drainage, lumen-apposing metal stents, and protocolized step-up strategies, the clinical practice remains heterogeneous, with variability in endoscopic strategies, procedural timing, device selection, and adjunctive techniques contributing to inconsistent outcomes. This review synthesizes current evidence to contribute to a structured framework integrating multidisciplinary team decision-making, advanced imaging (three-dimensional reconstruction, contrast-enhanced computed tomography/magnetic resonance imaging), EUS assessment, and biomarker-driven risk stratification (C-reactive protein, procalcitonin) to optimize patient selection, intervention timing, and complication management. Key standardization components include endoscopic assessment and procedural strategies, optimal timing of intervention, personalized approaches for complex pancreatic collections, and techniques to reduce the number of endoscopic debridements and mitigate complications. This work aims to enhance clinical outcomes, minimize practice heterogeneity, and establish a foundation for future research and guideline development in endoscopic management of INP.
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Affiliation(s)
- Yan Zeng
- Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Jun-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jian Yang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Bu M, Zhang Y, Xie X, Li K, Li G, Tong Z, Li W. Influencing factor analysis and clinical efficacy of early intervention in severe acute pancreatitis with persistent organ failure. Sci Rep 2025; 15:16230. [PMID: 40346177 PMCID: PMC12064800 DOI: 10.1038/s41598-025-98532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 04/14/2025] [Indexed: 05/11/2025] Open
Abstract
This study aims to analyze the risk factors requiring early intervention in severe acute pancreatitis (SAP) patients with persistent organ failure and evaluate the clinical outcomes following treatment. This was a retrospective observational study. Inverse probability treatment weighting using propensity score methods was employed to balance baseline characteristics. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with early intervention. Smooth curve fitting was applied to explore potential relationships between variables and intervention timing. Threshold effect analysis was conducted to identify the optimal inflection point in nonlinear relationship. A total of 310 patients were included in this study. Compared to the standard treatment group (n = 162), the early intervention group (n = 148) had a higher proportion of multiple organ failure (77.1% vs. 63.6%, P = 0.021) and higher mortality (27.7% vs. 16.0%, P = 0.013), but early intervention was not significantly associated with adverse outcome (OR 1.52, 95% CI 0.71-3.26, P = 0.283). Risk factors associated with early intervention included computed tomography severity index, SOFA score, intra-abdominal pressure (IAP), and remifentanil equivalents. Among these, the SOFA score showed a negative linear relationship with intervention timing, while distinct threshold effects were observed between IAP, remifentanil equivalents, and intervention timing. One week after intervention, most patients showed improved organ function, along with reduced requirements for sedation and analgesia, as well as decreased C-reactive protein level levels and IAP (all P < 0.05). SAP patients requiring early intervention tended to have higher disease severity. Although early intervention can improve short-term organ function, reduce IAP, and lower analgesic requirements, its impact on reducing mortality remains uncertain.
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Affiliation(s)
- Minchun Bu
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China
| | - Yun Zhang
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaochun Xie
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Kaiming Li
- Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Gang Li
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China.
| | - Zhihui Tong
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China
| | - Weiqin Li
- Medical College of Yangzhou University, Yangzhou, 225000, Jiangsu Province, People's Republic of China.
- Department of Critical Care Medicine, Center of Severe Acute Pancreatitis (CSAP), Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu Province, People's Republic of China.
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Meier J, Lucius C, Möller K, Jenssen C, Zervides C, Gschmack AM, Dong Y, Srivastava D, Dietrich CF. Pancreatic ultrasound: An update of measurements, reference values, and variations of the pancreas. Ultrasound Int Open 2024; 10:a23899085. [PMID: 39411753 PMCID: PMC11475099 DOI: 10.1055/a-2389-9085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 08/09/2024] [Indexed: 10/19/2024] Open
Abstract
Reliable and reproducible measurement methods have been established, and reference values are used in almost all scientific disciplines. Knowledge of reference values is crucial to distinguish physiological from pathological processes and, therefore, subsequently, for the clinical management of patients. Image storage and documentation of measurements and normal findings should be part of quality assurance in imaging. This paper aims to review the published literature and provide current knowledge of sonographic measurements and reference values of the pancreas. Moreover, the role of clinical influencing factors such as age, gender, constitution, and ethnicity is also analyzed.
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Affiliation(s)
- Jennifer Meier
- Department General Internal Medicine, Hirslanden Hospital Beau Site,
Bern, Switzerland
| | - Claudia Lucius
- Outpatient Department of Gastroenterology, IBD center, Policlinic
Helios Klinikum Buch, Berlin, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital,
Berlin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Hospital Maerkisch Oderland,
Strausberg, Germany and Brandenburg Institute for Clinical Ultrasound,
Neuruppin, Germany
| | | | | | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to
Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - David Srivastava
- Department of Emergency Medicine Inselspital, University Hospital Bern,
University of Bern, Bern, Switzerland
| | - Christoph F. Dietrich
- Department General Internal Medicine, Hirslanden Hospital Beau Site,
Bern, Switzerland
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Wang YF, Wu Y, Liu XW, Li JG, Zhan YQ, Liu B, Fan WL, Peng ZH, Xiao JT, Li BB, He J, Yi J, Lu ZX. Effect of a disposable endoscope precleaning kit in the cleaning procedure of gastrointestinal endoscope: A multi-center observational study. World J Gastrointest Endosc 2023; 15:705-714. [PMID: 38187912 PMCID: PMC10768042 DOI: 10.4253/wjge.v15.i12.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Precleaning is a key step in endoscopic reprocessing.
AIM To develop an effective and economic endoscope cleaning method by using a disposable endoscope bedside precleaning kit.
METHODS Altogether, 228 used gastrointestinal endoscopes were selected from five high-volume endoscopy units and precleaned by a traditional precleaning bucket (group T) or a disposable endoscope bedside precleaning kit (group D). Each group was further subdivided based on the replacement frequency of the cleaning solution, which was replaced every time in subgroups T1 and D1 and every several times in subgroups Ts and Ds. The adenosine triphosphate (ATP) level and residual proteins were measured three times: Before and after precleaning and after manual cleaning.
RESULTS After precleaning, the precleaning kit significantly reduced the ATP levels (P = 0.034) and has a more stable ATP clearance rate than the traditional precleaning bucket. The precleaning kit also saved a quarter of the cost of enzymatic detergent used during the precleaning process. After manual cleaning, the ATP levels were also significantly lower in the precleaning kit group than in the traditional precleaning bucket group (P < 0.05). Meanwhile, the number of uses of the cleaning solution (up to four times) has no significant impact on the cleaning effect (P > 0.05).
CONCLUSION Considering its economic cost and cleaning effect, the use of a disposable endoscope bedside precleaning kit can be an optimal option in the precleaning stage with the cleaning solution being replaced several times in the manual cleaning stage.
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Affiliation(s)
- Yi-Fan Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yu Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, Hunan Province, China
| | - Xiao-Wei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, National Research Center of Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jian-Guo Li
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha 410006, Hunan Province, China
| | - Yan-Qiong Zhan
- Department of Gastroenterology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Bin Liu
- Department of Gastroenterology, Xiangtan Central Hospital, Xiangtan 411100, Hunan Province, China
| | - Wen-Ling Fan
- Department of Gastroenterology, The First Hospital of Changsha, Changsha 410005, Hunan Province, China
| | - Zi-Heng Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jin-Tao Xiao
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Bing-Bing Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jian He
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jun Yi
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Zhao-Xia Lu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Capurso G, Tacelli M, Vanella G, Ponz de Leon Pisani R, Dell'Anna G, Abati M, Mele R, Lauri G, Panaitescu A, Nunziata R, Zaccari P, Archibugi L, Arcidiacono PG. Managing complications of chronic pancreatitis: a guide for the gastroenterologist. Expert Rev Gastroenterol Hepatol 2023; 17:1267-1283. [PMID: 38093702 DOI: 10.1080/17474124.2023.2295498] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Chronic pancreatitis is a heterogeneous and complex syndrome that, in most cases, causes pain as a cardinal symptom and affects both the morphology and function of the pancreas, leading to several serious complications. AREAS COVERED The present review, based on a non-systematic PubMed search updated to June 2023, aims to present the current available evidence on the role of gastroenterologists in the diagnosis and treatment of both local and systemic complications by either endoscopic or medical treatments. EXPERT OPINION At diagnosis and during chronic pancreatitis follow-up, particular care is needed to consider not only the clinically manifest signs and symptoms of the disease, such as pain, jaundice, gastrointestinal obstruction, and pseudocysts, which require multidisciplinary discussion to establish the best treatment option (endoscopic or surgical), but also less evident systemic complications. Pancreatic exocrine and endocrine insufficiency, together with chronic inflammation, addiction, and dysbiosis, contribute to malnutrition, sarcopenia, and osteopathy. These complications, in turn, increase the risk of infection, thromboembolic events, and death. Patients with chronic pancreatitis also have an increased risk of psychiatric disorders and pancreatic cancer onset. Overall, patients with chronic pancreatitis should receive a holistic evaluation, considering all these aspects, possibly through multidisciplinary care in dedicated expert centers.
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Affiliation(s)
- Gabriele Capurso
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Tacelli
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Ruggero Ponz de Leon Pisani
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Dell'Anna
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Abati
- Nutrition Service, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Mele
- Nutrition Service, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano Lauri
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Afrodita Panaitescu
- Vita-Salute San Raffaele University, Milan, Italy
- Bucharest Clinical Emergency Hospital, Bucharest, Romania
| | - Rubino Nunziata
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Piera Zaccari
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Livia Archibugi
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Tang P, Ali K, Khizar H, Ni Y, Cheng Z, Xu B, Qin Z, Zhang W. Endoscopic versus minimally invasive surgical approach for infected necrotizing pancreatitis: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2023; 55:2276816. [PMID: 37930932 PMCID: PMC10629416 DOI: 10.1080/07853890.2023.2276816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND/AIMS Acute pancreatitis is a common condition of the digestive system, but sometimes it develops into severe cases. In about 10-20% of patients, necrosis of the pancreas or its periphery occurs. Although most have aseptic necrosis, 30% of cases will develop infectious necrotizing pancreatitis. Infected necrotizing pancreatitis (INP) requires a critical treatment approach. Minimally invasive surgical approach (MIS) and endoscopy are the management methods. This meta-analysis compares the outcomes of MIS and endoscopic treatments. METHODS We searched a medical database until December 2022 to compare the results of endoscopic and MIS procedures for INP. We selected eligible randomized controlled trials (RCTs) that reported treatment complications for the meta-analysis. RESULTS Five RCTs comparing a total of 284 patients were included in the meta-analysis. Among them, 139 patients underwent MIS, while 145 underwent endoscopic procedures. The results showed significant differences (p < 0.05) in the risk ratios (RRs) for major complications (RR: 0.69, 95% confidence interval (CI): 0.49-0.97), new onset of organ failure (RR: 0.29, 95% CI: 0.11-0.82), surgical site infection (RR: 0.26, 95% CI: 0.07-0.92), fistula or perforation (RR: 0.27, 95% CI: 0.12-0.64), and pancreatic fistula (RR: 0.14, 95% CI: 0.05-0.45). The hospital stay was significantly shorter for the endoscopic group compared to the MIS group, with a mean difference of 6.74 days (95% CI: -12.94 to -0.54). There were no significant differences (p > 0.05) in the RR for death, bleeding, incisional hernia, percutaneous drainage, pancreatic endocrine deficiency, pancreatic exocrine deficiency, or the need for enzyme use. CONCLUSIONS Endoscopic management of INP performs better compared to surgical treatment due to its lower complication rate and higher patient life quality.
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Affiliation(s)
- Penghao Tang
- Graduate School of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kamran Ali
- Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Zhejiang, China
| | - Hayat Khizar
- Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Zhejiang, China
| | - Yuanzhi Ni
- Graduate School of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiwen Cheng
- Graduate School of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Benfeng Xu
- Graduate School of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhiwen Qin
- Graduate School of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wu Zhang
- Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Zhejiang, China
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