Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis
Abstract Objectives Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta‐analysis was conducted to evaluat...
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Wiley
2023-04-01
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| Online Access: | https://doi.org/10.1002/deo2.171 |
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| author | Yousuke Nakai Hideyuki Shiomi Tsuyoshi Hamada Shogo Ota Mamoru Takenaka Takuji Iwashita Tatsuya Sato Tomotaka Saito Atsuhiro Masuda Saburo Matsubara Keisuke Iwata Tsuyoshi Mukai Hiroyuki Isayama Ichiro Yasuda |
| author_facet | Yousuke Nakai Hideyuki Shiomi Tsuyoshi Hamada Shogo Ota Mamoru Takenaka Takuji Iwashita Tatsuya Sato Tomotaka Saito Atsuhiro Masuda Saburo Matsubara Keisuke Iwata Tsuyoshi Mukai Hiroyuki Isayama Ichiro Yasuda |
| author_sort | Yousuke Nakai |
| collection | DOAJ |
| description | Abstract Objectives Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta‐analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut‐off defined in the revised Atlanta classification (≤4 vs. >4 weeks). Methods Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random‐effects model. Results We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66–3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21–2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15–1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. Conclusions Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies. |
| format | Article |
| id | doaj-art-78db0396ac534e1b92a1e2d38ab35822 |
| institution | DOAJ |
| issn | 2692-4609 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj-art-78db0396ac534e1b92a1e2d38ab358222025-08-20T03:10:01ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.171Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysisYousuke Nakai0Hideyuki Shiomi1Tsuyoshi Hamada2Shogo Ota3Mamoru Takenaka4Takuji Iwashita5Tatsuya Sato6Tomotaka Saito7Atsuhiro Masuda8Saburo Matsubara9Keisuke Iwata10Tsuyoshi Mukai11Hiroyuki Isayama12Ichiro Yasuda13Department of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo JapanDivision of Gastroenterology and Hepatobiliary and Pancreatic Diseases Department of Internal Medicine Hyogo Medical University Hyogo JapanDepartment of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo JapanDivision of Gastroenterology and Hepatobiliary and Pancreatic Diseases Department of Internal Medicine Hyogo Medical University Hyogo JapanDepartment of Gastroenterology and Hepatology Kindai University Faculty of Medicine Osaka JapanFirst Department of Internal Medicine Gifu University Hospital Gifu JapanDepartment of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo JapanDepartment of Gastroenterology Graduate School of Medicine The University of Tokyo Tokyo JapanDivision of Gastroenterology Department of Internal Medicine Kobe University Graduate School of Medicine Hyogo JapanDepartment of Gastroenterology and Hepatology, Saitama Medical Center Saitama Medical University Saitama JapanDepartment of Gastroenterology Gifu Municipal Hospital Gifu JapanDepartment of Gastroenterological Endoscopy Kanazawa Medical University Ishikawa JapanDepartment of Gastroenterology Graduate School of Medicine Juntendo University Tokyo JapanThird Department of Internal Medicine University of Toyama Toyama JapanAbstract Objectives Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta‐analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut‐off defined in the revised Atlanta classification (≤4 vs. >4 weeks). Methods Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random‐effects model. Results We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66–3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21–2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15–1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. Conclusions Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies.https://doi.org/10.1002/deo2.171acute necrotizing pancreatitisdrainageendoscopic ultrasoundnecrosectomywalled‐off necrosis |
| spellingShingle | Yousuke Nakai Hideyuki Shiomi Tsuyoshi Hamada Shogo Ota Mamoru Takenaka Takuji Iwashita Tatsuya Sato Tomotaka Saito Atsuhiro Masuda Saburo Matsubara Keisuke Iwata Tsuyoshi Mukai Hiroyuki Isayama Ichiro Yasuda Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis DEN Open acute necrotizing pancreatitis drainage endoscopic ultrasound necrosectomy walled‐off necrosis |
| title | Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis |
| title_full | Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis |
| title_fullStr | Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis |
| title_full_unstemmed | Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis |
| title_short | Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis |
| title_sort | early versus delayed interventions for necrotizing pancreatitis a systematic review and meta analysis |
| topic | acute necrotizing pancreatitis drainage endoscopic ultrasound necrosectomy walled‐off necrosis |
| url | https://doi.org/10.1002/deo2.171 |
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