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Open Access Research article

Endoscopic ultrasound criteria to predict the need for intervention in pancreatic necrosis

Christian Jürgensen1*, Alexander Arlt2, Frank Neser3, Annette Fritscher-Ravens2, Ulrich Stölzel3 and Jochen Hampe2

Author Affiliations

1 Department of Gastroenterology, Charité University Campus Mitte, Berlin, Germany

2 Interdisciplinary Endoscopy, Department of Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

3 Department of Medicine II, Klinikum Chemnitz, Chemnitz, Germany

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BMC Gastroenterology 2012, 12:48  doi:10.1186/1471-230X-12-48

Published: 14 May 2012

Abstract

Background

The natural course and treatment strategies for asymptomatic or oligosymptomatic pancreatic necrosis are still poorly defined. The aim of this retrospective study was to establish criteria for the need of intervention in patients with pancreatic necrosis.

Methods

A total of 31 consecutive patients (18 male, median age 58 yrs.) diagnosed with pancreatic necrosis by endoscopic ultrasound, in whom a decision for initial conservative treatment was made, were followed for the need of interventions such as endoscopic or surgical intervention, or death.

Results

After a median follow-up of 243 days, 21 patients remained well without intervention and in 10 patients an endpoint event occurred. In a multivariate logistic regression analysis of the clinical and endosonographic parameters, liquid content was the single independent predictor for intervention (p = 0.0006). The presence of high liquid content in the pancreatic necrosis resulted in a 64% predicted endpoint risk as compared to 2% for solid necrosis.

Conclusions

Pancreatic necrotic cavities with high liquid content are associated with a high risk of complications. Therefore, close clinical monitoring is needed and early elective intervention might be considered in these patients.