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Background: Recent studies showed that the clinical outcome of moderately severe acute pancreatitis (MSAP) are different among different subgroups. Aims: To further subdivide MSAP, and explore the heterogeneity of MSAP subgroups. Methods: A retrospective analysis was performed on patients with acute pancreatitis (AP) from January 2016 to December 2020 at Northern Jiangsu People’s Hospital, including 538 patients with mild acute pancreatitis (MAP) and 461 patients with MSAP. MSAP patients were divided into four groups according to local complication and transient organ failure (TOF), including single acute peripancreatic fluid collection (APFC) without TOF group (group A), multiple APFC without TOF group (group B), other local complication without TOF group (group C) and TOF group (group D). The baseline data and the severity of AP among the four subgroups were compared. Meanwhile, the severity of disease between group A and MAP patients was also compared. Logistic regression analysis was used to evaluate the risk factors of MSAP. Results: Patients in group D were older than those in group A (P<0.05). There were statistically significant differences in different scoring systems among the four subgroups (P<0.05). The proportions of APACHE Ⅱ≥8, Glasgow≥3 and BISAP≥3 in group D were significantly higher than those in the other three groups (P<0.05). There were significant differences in levels of Ca
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Objective To investigate the value of endoscopic ultrasound ( EUS)-guided drainage via upper gastrointestinal tract for peripancreatic fluid collection. Methods The clinical data of 103 patients with peripancreatic fluid collection undergoing EUS-guided drainage via upper gastrointestinal tract from May 2006 to July 2017 in Nanjing Drum Tower Hospital were retrospectively analyzed, the treatment and postoperative complications were summarized. Results Among the 103 patients, 101 ( 98. 1％) were punctured successfully, and patients were punctured mostly through the gastric wall (97. 1％, 100/103). There were 29 cases of metal stent placement, and 66 plastic stent placement. Ten patients underwent ERCP with pancreatic stent placement. After operation, 8 patients underwent percutaneous drainage, and 1 surgical drainage. Complications occurred in 14 ( 13. 6％) cases, including stent displacement in 5 cases, and postoperative infection in 9 cases. There was no perforation, bleeding, pancreatic fistula, other serious complications or death. Conclusion EUS-guided drainage is safe and reliable for peripancreatic fluid collection.
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Objective To assess the application value of lumen-apposing,fully covered,self-expandable metal stent (LAMS) in the treatment of peripancreatic fluid collection (PFC).Methods From July 2015 to July 2017,at Drum Tower Hospital Affiliated to Medical School of Nanjing University,the patients with PFC who received LAMS under endoscopic ultrasound were enrolled.The inclusion criteria was the first treatment,age ≥ 18 years old,PFC diameter ＞ 6 cm and clinical manifestations of compression,or increased diameter of PFC after continuous observation,or signs of infection,course ＞four weeks,and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm;exclude other pancreatic cystic lesions,such as serous cystic neoplasm,mucinous cystic neoplasm and solid pseudopapillary neoplasm.The clinical data of enrolled patients were retrospectively analyzed,and the efficacy and postoperative complication were summarized.Results A total of 27 patients with PFC were enrolled.All patients were successfully punctured and placed with LAMS.The percentage of complete drainage rate of PFC was 96.3％ (26/27).The median LAMS maintenance time was 26 days,with a range of four to 135 days.Seventeen patients received debridement treatment through LAMS,and the number of debridement treatment was (2.5± 1.3) times.Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were placed with pancreatic stent,five patients received percutaneous drainage,and one patient underwent surgical drainage.Among 27 patients with PFC,eight patients (29.6％) coexisted with complications,including stent displacement in two cases,postoperative infection in three cases,perforation in two cases and bleeding in one case.They all improved after conservative treatment and none of them died.Conclusion LAMS is effective and relatively safe in the treatment of PFC,and may change the clinical treatment strategy of PFC.
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Objective To study the Effect of acute peripancreatitc fluid collection and pancreatic necrosis to the prognosis of acute pancreatitis.Methods Retrospectively analyzing the prognostic effect of acute peripancreatitc fluid collection and pancreatic necrosis according to the early Computed-Tomograghy of 323 consecutive acute pancreatitis patients from Jan 2003 to Dec 2007,the end points are systemic inflammation response syndrome ( SIRS),pancreatic infection,and mortality.Results Within 5d after onset,97 of 323 cases (30%) presented with SIRS and lasted more than 2d,12 cases (3.7%) occurred pancreatic infection during middle or late phase,14 cases died,the mortality is 4.3%.141 of 323 cases (43.7%) who had acute peripancreatic fluid collection presented with SIRS,acute peripancreatic fluid collection correlated significantly with the occurrence of SIRS,P ＜ 0.05.227 cases (277/323,85.8%) had no pancreatic necrosis,no pancreatic infection occurred,46 cases (46/323,14.2% )had pancreatic necrosis,pancreatic necrosis correlated significantly with pancreatic infection,P ＜ 0.05.Conclusions Acute poripancreafic fluid collection and pancreatic necrosis had different prognostic effect to acute pancreatitis.Acute peripancreatic fluid collection correlated well with the occurrence of SIRS during the early phase;Pancreatic necrosis may be infected during middle or late phase of acute pancreatitis,more extent of pancreatic necrosis,more possible that pancreatic infection will occur.