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2014 ; 27
(3
): 258-261
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Morphological features of fluid collections on endoscopic ultrasound in acute
necrotizing pancreatitis: do they change over time?
#MMPMID24975052
Rana SS
; Bhasin DK
; Reddy YR
; Sharma V
; Rao C
; Sharma RK
; Gupta R
Ann Gastroenterol
2014[]; 27
(3
): 258-261
PMID24975052
show ga
BACKGROUND: There have been attempts to develop universally applicable
nomenclature for pancreatic fluid collections (PFCs) in acute pancreatitis. But
PFCs following acute necrotizing pancreatitis (ANP) has not been studied by
sensitive imaging techniques like endoscopic ultrasound (EUS). The aim of the
study was to prospectively study morphological structure of pancreatic fluid
collections occurring after ANP by serial EUS. METHODS: Patients with ANP having
PFC at ?4 weeks of onset of symptoms seen at our center from October 2011 to
November 2012 were prospectively followed up with EUS at 6 weeks, 3 months and 6
months respectively and the amount of solid content in the collection was
quantified as percentage amount of echogenic material. The symptomatic patients
undergoing EUS/percutaneous drainage also underwent EUS prior to drainage for
assessment of solid content. RESULTS: Of the 54 patients enrolled, 7 patients
were lost to follow up or refused EUS. Forty seven patients (34 males; mean age
36.7±11.6 years) were studied. Etiology of acute pancreatitis was alcohol (n=22),
gallstones (n=10), idiopathic (10), gallstones+alcohol (n=3) and drug induced
(n=2). Contrast enhanced computed tomography done after 3 days of onset of ANP
had shown less than 30%, 30-50% and more than 50% necrosis in 6 (13%), 14 (30%)
and 27 (57%) patients respectively. On EUS at 6 weeks, 41/47 (87%) patients had
fluid collection with solid debris. Follow up EUS at 3 and 6 months revealed
progressively decreasing solid content in PFCs. CONCLUSIONS: All PFCs following
ANP may not have solid necrotic content and over a period of time necrotic
content tends to liquefy. This may have therapeutic implications.