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Abstract
Background Pancreatic fluid collections (PFCs) are seen in 50% of patients with severe acute pancreatitis. It is necessary to classify these collections as a given significant differences in outcome and management. Management of PFCs has increasingly shifted to less invasive modalities like conservative management or EUS-guided drainage rather than more invasive modalities like percutaneous or surgical drainage. In this study, we aimed to estimate demographics, clinical profile, modalities of treatment, and their success according to the type of PFCs.
Methods Ninety patients with PFCs were recruited for this retrospective and prospective observational study. The patients’ demographics, clinical profiles, laboratory investigations, and radiological findings were noted. According to various types of PFCs, the modality of management was given to the patients, and the outcomes were studied.
Results Out of 90 patients, 76 (84.4%) were male. The most common etiology is alcohol (65.5%), followed by idiopathic (16.7%), cholelithiasis (14%), and traumatic (3.33%). The most common type of PFC was acute necrotic collection (33.3%), followed by pancreatic pseudocyst (32%), walled of necrosis (18.8 %), and acute pancreatic fluid collection (7.7 %) (IDDF2024-ABS-0319 Figure 1. Distribution of study population according to the type of PFC). 58% of patients responded to conservative management; however, 42% of patients required intervention in the form of EUS-guided drainage, percutaneous drainage, or surgical intervention. Out of 30 patients with acute necrotic collection, 20 (66.6%) patients were cured with conservative management, 10 patients (33.3%) required percutaneous drainage, and 2 patients developed recurrence and were referred for surgical intervention. All patients with acute pancreatic fluid collection responded to conservative management. 68% of patients with pseudocyst responded to conservative management, while 32% required EUS-guided drainage. Only 35% of patients with WON responded to conservative management, while 65 % required drainage either by EUS-guided drainage (54 %) or percutaneous drainage (11%) (IDDF2024-ABS-0319 Figure 2. Distribution of study population according to treatment modalities for various PFCS). Mortality rate as follows: acute necrotic collection patients (16.6%), pancreatic pseudocyst (6.9%), WON (6%) (IDDF2024-ABS-0319 Figure 3. Distribution of study population according to outcome of various PFCS).
Distribution of study population according to the type of PFC.
Distribution of study population according to treatment modalities for various PFCS.
Conclusions Although PFCs are commonly seen in acute severe pancreatitis, most of them resolve spontaneously with conservative management. Appropriate clinical decision-making is necessary for timely intervention in PFCs to prevent further adverse consequences. EUS-guided drainage shows better results with fewer complications in well-defined symptomatic PFCs and replacing more invasive percutaneous drainage or surgical drainage for PFCs.