Long-term follow-up study of necrotising pancreatitis: Interventions, complications and quality of life

Robbert A. Hollemans, Hester C. Timmerhuis*, Marc G. Besselink, Stefan A.W. Bouwense, Marco Bruno, Peter Van Duijvendijk, Erwin Jan Van Geenen, Muhammed Hadithi, Sybrand Hofker, Jeanin E. Van-Hooft, Liesbeth M. Kager, Eric R. Manusama, Jan Werner Poley, Rutger Quispel, Tessa Römkens, George P. Van Der Schelling, Matthijs P. Schwartz, Bernhard W.M. Spanier, Martijn Stommel, Adriaan TanNiels G. Venneman, Frank Vleggaar, Roy L.J. Van Wanrooij, Thomas L. Bollen, Rogier P. Voermans, Robert C. Verdonk, Hjalmar C. Van Santvoort

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    3 Citations (Scopus)

    Abstract

    Objective: To describe the long-term consequences of necrotising pancreatitis, including complications, the need for interventions and the quality of life. 

    Design: Long-term follow-up of a prospective multicentre cohort of 373 necrotising pancreatitis patients (2005-2008) was performed. Patients were prospectively evaluated and received questionnaires. Readmissions (ie, for recurrent or chronic pancreatitis), interventions, pancreatic insufficiency and quality of life were compared between initial treatment groups: conservative, endoscopic/percutaneous drainage alone and necrosectomy. Associations of patient and disease characteristics during index admission with outcomes during follow-up were assessed. 

    Results: During a median follow-up of 13.5 years (range 12-15.5 years), 97/373 patients (26%) were readmitted for recurrent pancreatitis. Endoscopic or percutaneous drainage was performed in 47/373 patients (13%), of whom 21/47 patients (45%) were initially treated conservatively. Pancreatic necrosectomy or pancreatic surgery was performed in 31/373 patients (8%), without differences between treatment groups. Endocrine insufficiency (126/373 patients; 34%) and exocrine insufficiency (90/373 patients; 38%), developed less often following conservative treatment (p<0.001 and p=0.016, respectively). Quality of life scores did not differ between groups. Pancreatic gland necrosis >50% during initial admission was associated with percutaneous/endoscopic drainage (OR 4.3 (95% CI 1.5 to 12.2)), pancreatic surgery (OR 3.2 (95% CI 1.1 to 9.5) and development of endocrine insufficiency (OR13.1 (95% CI 5.3 to 32.0) and exocrine insufficiency (OR6.1 (95% CI 2.4 to 15.5) during follow-up. 

    Conclusion: Acute necrotising pancreatitis carries a substantial disease burden during long-term follow-up in terms of recurrent disease, the necessity for interventions and development of pancreatic insufficiency, even when treated conservatively during the index admission. Extensive (>50%) pancreatic parenchymal necrosis seems to be an important predictor of interventions and complications during follow-up.

    Original languageEnglish
    Article number329735
    JournalGut
    DOIs
    Publication statusE-pub ahead of print - 24-Jan-2024

    Keywords

    • ACUTE PANCREATITIS
    • INTERVENTIONAL RADIOLOGY
    • PANCREATIC SURGERY
    • PANCREATITIS
    • THERAPEUTIC ENDOSCOPY

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