Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

AIM:To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis(SAP).METHODS:A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization.An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d.The sinus tract of the drainage catheter was expanded gradually with a skin expander,and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d.Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.RESULTS:Among the 42 patients,the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts.No death and complication occurred during the procedure.CONCLUSION:Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

Ultrasound-guided percutaneous catheter drainage in early treatment of severe acute pancreatitis

Percutaneous catheter drainage （PCD） is a minimally invasive intervation for severe acute pancreatitis （SAP）. This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP. In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography （CT） and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD. The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group （0%）. There was a significant difference between the two groups （P=0.044）. The mean time for recovery of the serum C-reactive protein （CRP） level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group （23.8 days） （P=0.034）. Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.

Value of neutrophil-lymphocyte ratio in evaluating response to percutaneous catheter drainage in patients with acute pancreatitis

BACKGROUND Early prediction of response to percutaneous catheter drainage(PCD)of necrotic collections in acute pancreatitis(AP)using simple and objective tests is critical as it may determine patient prognosis.The role of white blood cell(WBC)count and neutrophil-lymphocyte ratio(NLR)has not been assessed as a tool of early prediction of PCD success and is the focus of this study.AIM To assess the value of WBC and NLR in predicting response to PCD in AP.METHODS This retrospective study comprised consecutive patients with AP who underwent PCD between June 2018 and December 2019.Severity and fluid collections were classified according to the revised Atlanta classification and organ failure was defined according to the modified Marshall Score.WBC and NLR were monitored 24 h prior PCD(WBC-0/NLR-0)and 24 h(WBC-1/NLR-1),48 h(WBC-2/NLR-2)and 72 h(WBC-3/NLR-3)after PCD.NLR was calculated by dividing the number of neutrophils by the number of lymphocytes.The association of success of PCD(defined as survival without the need for surgery)with WBC and NLR was assessed.The trend of WBC and NLR was also assessed post PCD.RESULTS One hundred fifty-five patients[median age 40±13.6(SD),64.5%males,53.5%severe AP]were included in the final analysis.PCD was done for acute necrotic collection in 99(63.8%)patients and walled-off necrosis in 56(36.1%)patients.Median pain to PCD interval was 24±69.89 d.PCD was successful in 109 patients(group 1)and 46 patients(group 2)who failed to respond.There was no significant difference in the baseline characteristics between the two groups except the severity of AP and frequency of organ failure.Both WBC and NLR showed an overall decreasing trend.There was a significant difference between WBC-0 and WBC-1(P=0.0001).WBC-1 and NLR-1 were significantly different between the two groups(P=0.048 and 0.003,respectively).The area under the curve of WBC-1 and NLR-1 for predicting the success of PCD was 0.602 and 0.682,respectively.At a cut-off value of 9.87 for NLR-1,the sensitivity and specificity for predicting the success of PCD were calculated to be 75%and 65.4%respectively.CONCLUSION WBC and NLR can be used as simple tests for predicting response to PCD in patients with acute necrotizing pancreatitis.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Surgical management of necrotizing pancreatitis:An overview

Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of infection.Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity.This approach is however associated with poor outcomes.Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches.Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds:Delay,Drain and Debride.Patients can be managed in the intensive care unit and any intervention should be delayed.Percutaneous drainage can be utilized first and early in the course of the disease,followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary.Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach.The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.

Amebic liver abscess by Entamoeba histolytica

Amebic liver abscesses(ALAs)are the most commonly encountered extraintestinal manifestation of human invasive amebiasis,which results from Entamoeba histolytica(E.histolytica)spreading extraintestinally.Amebiasis can be complicated by liver abscess in 9%of cases,and ALAs led to almost 50000 fatalities worldwide in 2010.Although there have been fewer and fewer cases in the past several years,ALAs remain an important public health problem in endemic areas.E.histolytica causes both amebic colitis and liver abscess by breaching the host’s innate defenses and invading the intestinal mucosa.Trophozoites often enter the circulatory system,where they are filtered in the liver and produce abscesses,and develop into severe invasive diseases such as ALAs.The clinical presentation can appear to be colitis,including upper-right abdominal pain accompanied by a fever in ALA cases.Proper diagnosis requires nonspecific liver imaging as well as detecting anti-E.histolytica antibodies;however,these antibodies cannot be used to distinguish between a previous infection and an acute infection.Therefore,diagnostics primarily aim to use PCR or enzyme-linked immunosorbent assay to detect E.histolytica.ALAs can be treated medically,and percutaneous catheter drainage is only necessary in approximately 15%of cases.The indicated treatment is to administer an amebicidal drug(such as tinidazole or metronidazole)and paromomycin or other luminal cysticidal agent for clinical disease.Prognosis is good with almost universal recovery.Establishing which diagnostic methods are most efficacious will necessitate further analysis of similar clinical cases.