Benefits of abdominal paracentesis drainage performed ahead of percutaneous catheter drainage as a modification of the step-up approach in acute pancreatitis with fluid collections
| Journal | Volume 83 - 2020 |
| Issue | Fasc.2 - Original articles |
| Author(s) | E. Zerem 1 2, S. Kunosic 3, D. Zerem 4, A. Boloban 4, O. Zerem 5, E. Zlomužica 6 |
| Full article |
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Affiliations: (1) Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, Bistrik 7, 71000 Sarajevo, Bosnia and Herzegovina
(2) Department of health sciences, „Džemal Bijedic“ University of Mostar, 88000 Mostar, Bosnia and Herzegovina (3) Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina (4) Department of Internal Medicine, Cantonal Hospital „Safet Mujic“ Mostar, 88000 Mostar, Bosnia and Herzegovina (5) Medical Faculty, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina (6) Department of health sciences, „Džemal Bijedic” University of Mostar, 88000 Mostar, Bosnia and Herzegovina. |
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Aim: The aim of the study is to evaluate the role of abdominal paracentesis drainage (APD) ahead of percutaneous catheter drainage (PCD), as a modification of the step-up approach, when treating acute pancreatitis (AP) with peritoneal ascitic fluid (PAF). Patients and methods: This is a prospective cohort study including 118 participants with AP in which the indicative factors for upgrading from APD to PCD were investigated in patients with PAF. Ninety six patients with a sufficient volume of PAF initially underwent ultrasound-guided APD and were separated into two groups : group A (the patients who did not undergo PCD after APD) and B (the patients who underwent PCD after APD). Participants with AP who underwent PCD but lacked enough PAF for APD before PCD were followed up in a separate group (group C). Primary outcome was conversion rate to more aggressive procedure (percutaneous treatment modalities to surgery or death). Results: Of the 96 patients who underwent APD, 42 were managed with APD alone and 54 received PCD after APD (14 required necrosectomy after initial PCD). APD led to a large decrease in levels of the initial severity scores and laboratory variables in both groups of patients with PAF. The reduction in levels of all evaluated predictive severity scores and laboratory variables was similar (P>0.05) after APD. Conclusions: Application of APD ahead of PCD is safe and beneficial in the management of AP with abdominal or pelvic fluid collections. There are no relevant predictors that suggest whether APD is indicated or not. Keywords: acute pancreatitis, abdominal paracentesis drainage, percutaneois catheter drainage, the step-up approach, necrosectomy. |
| The authors declare that they have no conflict of interest. |
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© Acta Gastro-Enterologica Belgica. PMID 32603048 |
