Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis

Gupta,Pankaj; Koshi,Suzanne; Samanta,Jayanta; Mandavdhare,Harshal; Sharma,Vishal; Sinha,Saroj   K; Dutta,Usha; Kochhar,Rakesh

doi:10.3892/etm.2020.8897

Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis

Authors:
- Pankaj Gupta
- Suzanne Koshi
- Jayanta Samanta
- Harshal Mandavdhare
- Vishal Sharma
- Saroj K Sinha
- Usha Dutta
- Rakesh Kochhar
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Affiliations: Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Imaging and Research, Chandigarh, Punjab 160012, India, Department of Gastroenterology, Nehru Hospital, Postgraduate Institute of Medical Imaging and Research, Chandigarh, Punjab 160012, India
Published online on: June 17, 2020 https://doi.org/10.3892/etm.2020.8897
Pages: 2311-2316

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Abstract

One of the critical factors for predicting the success of percutaneous catheter drainage (PCD) is the mean CT density of collection. A higher CT density suggests more necrotic solid tissue within the collection. In the present study, a novel technique for PCD of the necrotic pancreatic collection with a higher mean CT density was evaluated. It was a retrospective study of patients with acute pancreatitis (AP) who underwent PCD of pancreatic collections between May 2018 and December 2018. Patients with pancreatic collections having a CT density of >30 Hounsfield Units (HU) were considered for PCD using the kissing catheter technique. This technique involved placing two catheters side‑by‑side through a single cutaneous entry site, as the conventional technique of PCD may not be effective. The technical details, outcomes and complications of this technique were recorded. A total of 10 patients with a mean age of 30 years underwent PCD using this technique. All patients had severe pancreatitis with a mean CT severity index of 9 (range, 8‑10). The mean CT density was 37 HU (range, 32‑56). Successful management with PCD alone was achieved in 8 patients. The other 2 patients underwent surgical necrosectomy. One patient who underwent surgical necrosectomy died. Minor complications occurred in 3 patients. The kissing catheter technique allows for a higher success rate of PCD compared with that of the conventional method of PCD, in collections with a higher mean CT density.

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1	van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, et al: Dutch Pancreatitis Study Group: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 362:1491–1502. 2010.PubMed/NCBI View Article : Google Scholar
2	Ke L, Li J, Hu P, Wang L, Chen H and Zhu Y: Percutaneous Catheter Drainage in Infected Pancreatitis Necrosis: A Systematic Review. Indian J Surg. 78:221–228. 2016.PubMed/NCBI View Article : Google Scholar
3	van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG and Gooszen HG: Dutch Pancreatitis Study Group. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg. 98:18–27. 2011.PubMed/NCBI View Article : Google Scholar
4	Mallick B, Dhaka N, Gupta P, Gulati A, Malik S, Sinha SK, Yadav TD, Gupta V and Kochhar R: An audit of percutaneous drainage for acute necrotic collections and walled off necrosis in patients with acute pancreatitis. Pancreatology. 18:727–733. 2018.PubMed/NCBI View Article : Google Scholar
5	van Grinsven J, Timmerman P, van Lienden KP, Haveman JW, Boerma D, van Eijck CH, Fockens P, van Santvoort HC, Boermeester MA and Besselink MG: Dutch Pancreatitis Study Group. Proactive Versus Standard Percutaneous Catheter Drainage for Infected Necrotizing Pancreatitis. Pancreas. 46:518–523. 2017.PubMed/NCBI View Article : Google Scholar
6	Sugimoto M, Sonntag DP, Flint GS, Boyce CJ, Kirkham JC, Harris TJ, Carr SM, Nelson BD, Bell DA, Barton JG, et al: Better Outcomes if Percutaneous Drainage Is Used Early and Proactively in the Course of Necrotizing Pancreatitis. J Vasc Interv Radiol. 27:418–425. 2016.PubMed/NCBI View Article : Google Scholar
7	Sugimoto M, Sonntag DP, Flint GS, Boyce CJ, Kirkham JC, Harris TJ, Carr SM, Nelson BD, Barton JG and Traverso LW: A percutaneous drainage protocol for severe and moderately severe acute pancreatitis. Surg Endosc. 29:3282–3291. 2015.PubMed/NCBI View Article : Google Scholar
8	Gupta P, Gupta J, Kumar C, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Gupta V, Yadav TD, Dutta U, et al: Aggressive Percutaneous Catheter Drainage Protocol for Necrotic Pancreatic Collections. Dig Dis Sci: Feb 5, 2020 (Epub ahead of print). doi: 10.1007/s10620-020-06116-6.
9	Hollemans RA, Bollen TL, van Brunschot S, Bakker OJ, Ahmed Ali U, van Goor H, Boermeester MA, Gooszen HG, Besselink MG and van Santvoort HC: Dutch Pancreatitis Study Group. Predicting Success of Catheter Drainage in Infected Necrotizing Pancreatitis. Ann Surg. 263:787–792. 2016.PubMed/NCBI View Article : Google Scholar
10	Tong Z, Li W, Yu W, Geng Y, Ke L, Nie Y, Sun J, Ni H, Wang X, Ye X, et al: Percutaneous catheter drainage for infective pancreatic necrosis: Is it always the first choice for all patients? Pancreas. 41:302–305. 2012.PubMed/NCBI View Article : Google Scholar
11	Guo Q, Li A and Hu W: Predictive factors for successful ultrasound-guided percutaneous drainage in necrotizing pancreatitis. Surg Endosc. 30:2929–2934. 2016.PubMed/NCBI View Article : Google Scholar
12	Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG and Vege SS: Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 62:102–111. 2013.PubMed/NCBI View Article : Google Scholar
13	Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, et al: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 32:1722–1732. 2006.PubMed/NCBI View Article : Google Scholar
14	Gupta P, Jain R, Koshi S, Gulati A, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U, Sandhu MS, et al: Radiation dose from computed tomography in patients with acute pancreatitis: An audit from a tertiary care referral hospital. Abdom Radiol (NY). 45:1517–1523, Epub ahead of print. 2020.PubMed/NCBI View Article : Google Scholar
15	Gupta P, Rana P, Bellam BL, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U and Kochhar R: Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis. Pancreatology. 20:9–15. 2020.PubMed/NCBI View Article : Google Scholar
16	Beger HG, Büchler M, Bittner R, Oettinger W, Block S and Nevalainen T: Necrosectomy and postoperative local lavage in patients with necrotizing pancreatitis: Results of a prospective clinical trial. World J Surg. 12:255–262. 1988.PubMed/NCBI View Article : Google Scholar
17	Freeny PC, Hauptmann E, Althaus SJ, Traverso LW and Sinanan M: Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: Techniques and results. AJR Am J Roentgenol. 170:969–975. 1998.PubMed/NCBI View Article : Google Scholar
18	Fotoohi M, D'Agostino HB, Wollman B, Chon K, Shahrokni S and vanSonnenberg E: Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: Role of cause and severity of pancreatitis. Radiology. 213:573–578. 1999.PubMed/NCBI View Article : Google Scholar
19	Baril NB, Ralls PW, Wren SM, Selby RR, Radin R, Parekh D, Jabbour N and Stain SC: Does an infected peripancreatic fluid collection or abscess mandate operation? Ann Surg. 231:361–367. 2000.PubMed/NCBI View Article : Google Scholar
20	Bruennler T, Langgartner J, Lang S, Wrede CE, Klebl F, Zierhut S, Siebig S, Mandraka F, Rockmann F, Salzberger B, et al: Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter? World J Gastroenterol. 14:725–730. 2008.PubMed/NCBI View Article : Google Scholar
21	Mortelé KJ, Girshman J, Szejnfeld D, Ashley SW, Erturk SM, Banks PA and Silverman SG: CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: Clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol. 192:110–116. 2009.PubMed/NCBI View Article : Google Scholar
22	Rocha FG, Benoit E, Zinner MJ, Whang EE, Banks PA, Ashley SW and Mortele KJ: Impact of radiologic intervention on mortality in necrotizing pancreatitis: The role of organ failure. Arch Surg. 144:261–265. 2009.PubMed/NCBI View Article : Google Scholar
23	van Grinsven J, van Dijk SM, Dijkgraaf MG, Boermeester MA, Bollen TL, Bruno MJ, van Brunschot S, Dejong CH, van Eijck CH, van Lienden KP, et al: Dutch Pancreatitis Study Group: Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial): Study protocol for a randomized controlled trial. Trials. 20(239)2019.PubMed/NCBI View Article : Google Scholar
24	Bansal A, Gupta P, Singh H, Samanta J, Mandavdhare H, Sharma V, Sinha SK, Dutta U and Kochhar R: Gastrointestinal complications in acute and chronic pancreatitis. JGH Open. 3:450–455. 2019.PubMed/NCBI View Article : Google Scholar
25	Gupta P, Chayan Das G, Sharma V, Mandavdhare H, Samanta J, Singh H, Kant Sinha S, Dutta U and Kochhar R: Role of computed tomography in prediction of gastrointestinal fistula in patients with acute pancreatitis. Acta Gastroenterol Belg. 82:495–500. 2019.PubMed/NCBI
26	Sikora SS, Khare R, Srikanth G, Kumar A, Saxena R and Kapoor VK: External pancreatic fistula as a sequel to management of acute severe necrotizing pancreatitis. Dig Surg. 22:446–451; discussion 452. 2005.PubMed/NCBI View Article : Google Scholar