The Diagnosis and Treatment of Local Complications of Acute Necrotizing Pancreatitis in China: A National Survey
Table 1
Survey questions and answers of respondents.
Survey questions
Survey answers
%
(1) Would you consider drainage for sterile ANC (no elevated body temperature, white blood cell count, or PCT) without definite indications of surgical intervention (uncontrolled bleeding, perforation, suspected necrosis, aggravating compartment syndrome, etc.)?
Never
57
18
Based on clinical condition, CT imaging, and laboratory indicators
229
71
Immediate intervention whenever possible
35
11
(1.1) For those who consider drainage for noninfected ANC based on clinical condition, CT imaging, and laboratory indicators (), what is the most important?
Persistent organ failure
126
55
Persistent abdominal pain and abdominal distention
39
17
CT shows a larger range of ANC
34
15
Laboratory indicators such as WBC, IL-6, CRP, and other inflammatory markers increase
18
8
Others
12
5
(1.1.1) For those who consider drainage for noninfected ANC based on persistent organ failure(), what is the criteria of duration and degree of organ failure when you consider drainage? (Multiple-choice questions)
Drainage when the duration of organ failure lasts 48 h
57
45
Drainage when the duration of organ failure lasts 1 week
21
17
Drainage when with new-onset organ failure
41
33
Drainage when organ failure aggravated
53
42
Drainage when the duration of organ failure lasts 2 weeks
9
7
Others
0
0
(2) For the drainage of ANC without infectious manifestations such as elevated body temperature, white blood cell count, or PCT, what is your first choice?
PCD
153
47
Endoscopic catheter drainage
12
4
Percutaneous or endoscopic catheter drainage based on the location of ANC
135
42
Surgical drainage
12
4
Others
9
3
(3) What is most important for the early suspicion of infected ANC?
Spiking of body temperatures to greater than 38.5°C
70
22
New-onset organ failure or deteriorated organ failure
82
26
Based on the imaging changes of CT or MRI
84
26
Based on laboratory indicators, such as PCT, hemogram, and platelet
27
8
Based on the result of fine needle aspiration
51
16
Others
7
2
(4) Is fine needle aspiration a routine practice for diagnosing IPN in your hospital?
Yes. Nearly every suspected IPN patients will do this
25
8
No. Only a part of patients do this
166
52
Never
130
40
(5) If IPN is suspected, what is the most important factor determining whether you intervene or not?
Based on the result of blood culture
7
2
Based on the occurrence and evolution of organ failure
45
14
Based on the efficacy of antibiotic therapy
79
25
Based on whether the disease extends beyond four weeks and the collection becomes walled off
112
35
Immediate drainage without considering other factors
72
22
Others
6
2
(6) If IPN is suspected or diagnosed but the course of the disease is less than 4 weeks (the collection is not well demarcated), what is your choice?
Antibiotic therapy alone
5
2
Catheter drainage when antibiotic therapy is ineffective
51
16
Antibiotic treatment and immediate drainage, but debride (including endoscopy or laparotomy) after 4 weeks (or wall formation) (including endoscopy or laparotomy)
162
50
Antibiotic treatment, meanwhile wait until 4 weeks (or wall formation) and then drainage or debridement
79
25
Immediately debridement (including endoscopy or laparotomy)
16
5
Others
8
2
(7) If IPN is suspected or diagnosed and the course of the disease has reached 4 weeks (or with WON), what is your first choice?
Antibiotic therapy alone
2
0
Catheter drainage when antibiotic therapy is ineffective
25
8
Antibiotic therapy meanwhile catheter drainage. The decision of debridement is made based on the step-up approach
Antibiotic therapy meanwhile laparotomy debridement and drainage
12
4
Others
7
2
(8) What is the preferred drainage approach in treating IPN when intervention is considered necessary in your hospital?
Step-up approach with PCD as the initial treatment
162
50
Step-up approach with endoscopic catheter drainage as the initial treatment
14
4
Step-up approach with PCD or endoscopic catheter drainage as the initial treatment based on the location of ANC
118
37
Direct laparotomy debridement and drainage
15
5
Others
12
4
(9) For walled-off necrosis (WON) with symptoms such as persistent abdominal pain, stomach outlet obstruction, and emaciation, what is your preferred treatment?
Observation without drainage
6
2
Step-up approach with PCD as the initial treatment
97
30
Step-up approach with endoscopic catheter drainage as the initial treatment
24
7
Step-up approach with PCD or endoscopic catheter drainage as the initial treatment based on the location of WON
