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Walled-Off Necrosis: Safety of Watchful Waiting

BACKGROUND: Asymptomatic pancreatic necrosis should be managed conservatively, regardless of its extent. However, late sequelae and safety of non-interventional management in patients with asymptomatic walled-off necrosis remain unclear. AIMS: The purpose of this study was to report the clinical out...

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Autores principales: Wroński, Marek, Cebulski, Włodzimierz, Pawłowski, Waldemar, Krasnodębski, Ireneusz W., Słodkowski, Maciej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408372/
https://www.ncbi.nlm.nih.gov/pubmed/25326117
http://dx.doi.org/10.1007/s10620-014-3395-9
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author Wroński, Marek
Cebulski, Włodzimierz
Pawłowski, Waldemar
Krasnodębski, Ireneusz W.
Słodkowski, Maciej
author_facet Wroński, Marek
Cebulski, Włodzimierz
Pawłowski, Waldemar
Krasnodębski, Ireneusz W.
Słodkowski, Maciej
author_sort Wroński, Marek
collection PubMed
description BACKGROUND: Asymptomatic pancreatic necrosis should be managed conservatively, regardless of its extent. However, late sequelae and safety of non-interventional management in patients with asymptomatic walled-off necrosis remain unclear. AIMS: The purpose of this study was to report the clinical outcome of outpatient expectant management in a cohort of patients with walled-off necrosis who were discharged asymptomatic after an episode of acute pancreatitis. METHODS: Sixteen patients with walled-off necrosis asymptomatic at discharge were identified retrospectively from a single institution. Data were analyzed for the type of complications, their incidence and treatment. RESULTS: Seven of 16 patients (44 %) did not experience any complications during a median follow-up of 17 months. Nine of 16 patients (56 %) became symptomatic or developed complications within a median follow-up of 49 days after discharge. The most common complication was infection of pancreatic necrosis which occurred in 7 of 9 patients. Six of these patients were successfully treated with minimally invasive techniques. In 5 of 7 patients, infection of necrosis was due to oral commensal bacteria. Acute intracavitary hemorrhage and intractable abdominal pain developed in one patient each. There was no mortality in this series. CONCLUSIONS: Outpatient watchful waiting can be used safely in patients with asymptomatic walled-off necrosis, although nearly half of them eventually develop complications which require interventional treatment. Most late infections of pancreatic necrosis are probably due to a blood-borne transmission of oral commensal bacteria.
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spelling pubmed-44083722015-04-30 Walled-Off Necrosis: Safety of Watchful Waiting Wroński, Marek Cebulski, Włodzimierz Pawłowski, Waldemar Krasnodębski, Ireneusz W. Słodkowski, Maciej Dig Dis Sci Original Article BACKGROUND: Asymptomatic pancreatic necrosis should be managed conservatively, regardless of its extent. However, late sequelae and safety of non-interventional management in patients with asymptomatic walled-off necrosis remain unclear. AIMS: The purpose of this study was to report the clinical outcome of outpatient expectant management in a cohort of patients with walled-off necrosis who were discharged asymptomatic after an episode of acute pancreatitis. METHODS: Sixteen patients with walled-off necrosis asymptomatic at discharge were identified retrospectively from a single institution. Data were analyzed for the type of complications, their incidence and treatment. RESULTS: Seven of 16 patients (44 %) did not experience any complications during a median follow-up of 17 months. Nine of 16 patients (56 %) became symptomatic or developed complications within a median follow-up of 49 days after discharge. The most common complication was infection of pancreatic necrosis which occurred in 7 of 9 patients. Six of these patients were successfully treated with minimally invasive techniques. In 5 of 7 patients, infection of necrosis was due to oral commensal bacteria. Acute intracavitary hemorrhage and intractable abdominal pain developed in one patient each. There was no mortality in this series. CONCLUSIONS: Outpatient watchful waiting can be used safely in patients with asymptomatic walled-off necrosis, although nearly half of them eventually develop complications which require interventional treatment. Most late infections of pancreatic necrosis are probably due to a blood-borne transmission of oral commensal bacteria. Springer US 2014-10-18 2015 /pmc/articles/PMC4408372/ /pubmed/25326117 http://dx.doi.org/10.1007/s10620-014-3395-9 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Article
Wroński, Marek
Cebulski, Włodzimierz
Pawłowski, Waldemar
Krasnodębski, Ireneusz W.
Słodkowski, Maciej
Walled-Off Necrosis: Safety of Watchful Waiting
title Walled-Off Necrosis: Safety of Watchful Waiting
title_full Walled-Off Necrosis: Safety of Watchful Waiting
title_fullStr Walled-Off Necrosis: Safety of Watchful Waiting
title_full_unstemmed Walled-Off Necrosis: Safety of Watchful Waiting
title_short Walled-Off Necrosis: Safety of Watchful Waiting
title_sort walled-off necrosis: safety of watchful waiting
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408372/
https://www.ncbi.nlm.nih.gov/pubmed/25326117
http://dx.doi.org/10.1007/s10620-014-3395-9
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