AI Article Synopsis
- The revised Atlanta classification includes patients with extrapancreatic fat necrosis (EXPN) under necrotizing pancreatitis, leading to the belief that they have better clinical outcomes, though data supporting this is limited.
- A post hoc analysis of 639 patients revealed that those with EXPN experienced significantly fewer complications like persistent organ failure and mortality compared to those with pancreatic parenchymal necrosis.
- While EXPN is associated with better outcomes overall, when infected necrosis occurs, the prognosis becomes similar to that of patients with pancreatic necrosis.
Article Abstract
Objective: In the revised Atlanta classification of acute pancreatitis, the term necrotising pancreatitis also refers to patients with only extrapancreatic fat necrosis without pancreatic parenchymal necrosis (EXPN), as determined on contrast-enhanced CT (CECT). Patients with EXPN are thought to have a better clinical outcome, although robust data are lacking.
Methods: A post hoc analysis was performed of a prospective multicentre database including 639 patients with necrotising pancreatitis on contrast-enhanced CT. All CECT scans were reviewed by a single radiologist blinded to the clinical outcome. Patients with EXPN were compared with patients with pancreatic parenchymal necrosis (with or without extrapancreatic necrosis). Outcomes were persistent organ failure, need for intervention and mortality. A predefined subgroup analysis was performed on patients who developed infected necrosis.
Results: 315 patients with EXPN were compared with 324 patients with pancreatic parenchymal necrosis. Patients with EXPN less often suffered from complications: persistent organ failure (21% vs 45%, p<0.001), persistent multiple organ failure (15% vs 36%, p<0.001), infected necrosis (16% vs 47%, p<0.001), intervention (18% vs 57%, p<0.001) and mortality (9% vs 20%, p<0.001). When infection of extrapancreatic necrosis developed, outcomes between groups were equal (mortality with infected necrosis: EXPN 28% vs pancreatic necrosis 18%, p=0.16).
Conclusion: EXPN causes fewer complications than pancreatic parenchymal necrosis. It should therefore be considered a separate entity in acute pancreatitis. Outcome in cases of infected necrosis is similar.
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| http://dx.doi.org/10.1136/gutjnl-2012-302870 | DOI Listing |
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