The Diagnosis and Treatment of Local Complications of Acute Necrotizing Pancreatitis in China: A National Survey

Xiaowu Dong; Wenjian Mao; Lu Ke; Lin Gao; Jing Zhou; Bo Ye; Gang Li; Anthony Phillips; Zhihui Tong; John Windsor; Weiqin Li; Chinese Acute Pancreatitis Clinical Trials Group Capctg

doi:10.1155/2021/6611149

The Diagnosis and Treatment of Local Complications of Acute Necrotizing Pancreatitis in China: A National Survey

Gastroenterol Res Pract. 2021 Jul 10:2021:6611149. doi: 10.1155/2021/6611149. eCollection 2021.

Authors

Xiaowu Dong^{1

2}, Wenjian Mao^{1

2}, Lu Ke², Lin Gao², Jing Zhou², Bo Ye², Gang Li², Anthony Phillips^{3

4}, Zhihui Tong², John Windsor^{3

4

5}, Weiqin Li^{1

2}, Chinese Acute Pancreatitis Clinical Trials Group Capctg⁶

Affiliations

¹ Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Clinical Medical College of Nanjing Medical University, No. 305 Zhongshan East Road, Nanjing, China.
² Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, China.
³ Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴ Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand.
⁵ HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
⁶ National Institute of Healthcare Data Science at Nanjing University, Nanjing, China.

Abstract

Background: The optimal management strategy in acute necrotizing pancreatitis (ANP) is debated, and compliance with current guidelines in China is not known. In this study, we performed a national survey on this topic in China.

Methods: An online questionnaire about the diagnosis and treatment of local complications of ANP was distributed through a national collaborative network. The local and systemic complications were defined according to the Revised Atlanta Classification.

Results: There were 321 survey respondents from the 394 who opened the link (response rate 81%) from 208 hospitals located in 30/34 provinces across China. There was a lack of consensus in terms of early diagnosis of infected pancreatic necrosis (IPN) as the respondents chose to depend on clinical symptoms (70/321, 22%), organ failure (82/321, 26%), imaging changes (84/321, 26%), and fine needle aspiration (51/321, 16%), respectively. A "step-up" approach has been widely adopted in patients with IPN (294/321, 92%). The decision for initial intervention (without confirmed/suspected infection) was based on clinical condition, CT imaging, or laboratory indicators for most respondents (229/321, 71%).

Conclusion: While the "step-up" approach has been widely adopted, there is still significant variation in regard to the diagnosis of infection, the best timing for drainage, and the indications for early intervention.