2025 conference-paper

Do we need to re-evaluate the role of fine-needle aspiration in infected necrotizing pancreatitis in the post-POINTER era?

Hannah S. Pauw, Astrid Beij, HC Timmerhuis, Lotte Boxhoorn, Marc G. Besselink, Marja A. Boermeester, MJ Bruno, Peter van Duijvendijk, Tessa E H Römkens, M Hadithi, Matthijs P. Schwartz, N G Venneman, Jeroen M. Jansen, Martijn W.J. Stommel, Rutger Quispel, Ben J.M. Witteman, W Curvers, Tom C. J. Seerden, Wouter L. Hazen, Stefan A.W. Bouwense, Marcel Spanier, Jan-Willem Haveman, Robert C. Verdonk, Elske Sieswerda, Rogier P. Voermans, Hjalmar C. van Santvoort, Fons F. van den Berg

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Le résumé fourni par la source

Aims Infected necrotizing pancreatitis is increasingly managed with delayed invasive intervention and conservative antibiotic therapy. In this context, fine needle aspiration (FNA) could play a crucial role by facilitating targeted, culture-based antimicrobial treatment. Our study aimed to assess the clinical value of FNA and its potential impact on antimicrobial therapy in a large cohort of patients with acute necrotizing pancreatitis. Methods We performed a post-hoc analysis of a Dutch prospective cohort of 618 patients with acute necrotizing pancreatitis (CTSI≥3) from 17 hospitals between 2010 and 2020. A fisher exact test was used for descriptive analysis. Results Of 618 patients with acute necrotizing pancreatitis, 72 patients (12%) underwent a total of 73 FNA procedures. Of the 73 procedures, 11 (15%) were endoscopic ultrasound-guided FNAs (EUS-FNA) and 62 (85%) were percutaneous FNAs. 58/73 (81%) FNA cultures were positive for bacteria and/or yeast, of which 40% were polymicrobial. 9/11 (82%) who underwent EUS-FNA had positive culture results and all were polymicrobial, as compared to 14/49 (29%) with percutaenous FNA (p<0.001). Enterobacteriaceae (72%) and fungi (55%) were more frequently cultured in EUS-FNA compared to percutaneous FNA (30%, p=0.002, 11%, p=0.015). No post-procedural complications were observed. 53/72 (74%) patients underwent subsequent (peri-)pancreatic drainage. Median time between FNA and drainage culture was 13 days (IQR 4-23). Level of agreement between FNA and drainage in terms of species identification was on average 40% (IQR100). Of 66 patients (92%) with available antimicrobial treatment data, 32 (48%) received antibiotics at the time of FNA. Differences in culture results were observed between patients who received antibiotics for 1 day or longer the week before FNA and those who did not. In 14/56 (25%) of the positive FNA cultures, the micro-organisms were resistant to three commonly administered empiric antibiotic regimes, of which 13/14 (93%) was due to Enterococcus Faecium. Conclusions FNA is a safe procedure for diagnosing infected necrotizing pancreatitis and guiding antimicrobial therapy. Poorly covered microbes by empirical therapy (i.e. Enterococcus, Candida) were frequently found. EUS-FNA cultures were often polymicrobial, likely due to peri-procedural contamination, and should be omitted. The long interval and in-between antibiotics seems to heavily impact the agreement between FNA and subsequent drainage cultures. Although large prospective studies are first needed, the role of FNA needs reconsideration, as it has the potential to optimize conservative treatment of infected necrotizing pancreatitis and help curb antimicrobial resistance. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.

Titre Crossref: Do we need to re-evaluate the role of fine-needle aspiration in infected necrotizing pancreatitis in the post-POINTER era?
Date Crossref: 01/03/2025
Éditeur: Georg Thieme Verlag KG
Type: proceedings-article

Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.

Où se fait cette recherche

St. Antonius Ziekenhuis pays non établi dans la notice
Organisme public
Amsterdam University Medical Centers pays non établi dans la notice
Établissement de santé
Amsterdam Gastroenterology Endocrinology Metabolism pays non établi dans la notice
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University of Amsterdam Amsterdam UMC pays non établi dans la notice
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Cancer Center Amsterdam pays non établi dans la notice
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Erasmus MC pays non établi dans la notice
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Canisius-Wilhelmina Ziekenhuis pays non établi dans la notice
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Gelre Hospitals pays non établi dans la notice
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Jeroen Bosch Ziekenhuis pays non établi dans la notice
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Maasstad Ziekenhuis pays non établi dans la notice
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Meander Medisch Centrum pays non établi dans la notice
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Medisch Spectrum Twente pays non établi dans la notice
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St. Antonius Ziekenhuis, Amsterdam University Medical Centers et Amsterdam Gastroenterology Endocrinology Metabolism, avec 9 autres affiliations.

Une affiliation ne permet pas de déduire la nationalité d’un auteur.

Les sujets associés

Pancreatitis Pathology and TreatmentPancreatic and Hepatic Oncology ResearchLiver Disease Diagnosis and Treatment

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