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Pancreas
Original research
Long-term follow-up study of necrotising pancreatitis: interventions, complications and quality of life
  1. Robbert A Hollemans1,2,
  2. Hester C Timmerhuis1,
  3. Marc G Besselink3,4,
  4. Stefan A W Bouwense5,
  5. Marco Bruno6,
  6. Peter van Duijvendijk7,
  7. Erwin-Jan van Geenen8,
  8. Muhammed Hadithi9,
  9. Sybrand Hofker10,
  10. Jeanin E Van-Hooft11,
  11. Liesbeth M Kager12,
  12. Eric R Manusama13,
  13. Jan-Werner Poley14,
  14. Rutger Quispel15,
  15. Tessa Römkens16,
  16. George P van der Schelling17,
  17. Matthijs P Schwartz18,
  18. Bernhard W M Spanier19,
  19. Martijn Stommel20,
  20. Adriaan Tan21,
  21. Niels G Venneman22,
  22. Frank Vleggaar23,
  23. Roy L J van Wanrooij24,
  24. Thomas L Bollen25,
  25. Rogier P Voermans26,
  26. Robert C Verdonk27,
  27. Hjalmar C van Santvoort1,28
  28. for the Dutch Pancreatitis Study Group
  1. 1 Department of Surgery, St Antonius Hospital Location, Utrecht, Netherlands
  2. 2 Department of Research and Development, St. Antonius Hospital, Nieuwegein, Netherlands
  3. 3 Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
  4. 4 Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
  5. 5 Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
  6. 6 Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
  7. 7 Department of Surgery, Gelre Hospitals, Apeldoorn, Netherlands
  8. 8 Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
  9. 9 Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands
  10. 10 Department of Surgery, University Medical Centre, Groningen, Netherlands
  11. 11 Department of Gastroenterology & Hepatology, Leiden Universitair Medisch Centrum, Leiden, Netherlands
  12. 12 Department of Gastroenterology & Hepatology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
  13. 13 Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
  14. 14 Department of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands
  15. 15 Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft, Netherlands
  16. 16 Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, Netherlands
  17. 17 Department of Surgery, Amphia Ziekenhuis, Breda, Netherlands
  18. 18 Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, Netherlands
  19. 19 Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, Netherlands
  20. 20 Department of Surgery, Radboudumc, Nijmegen, Netherlands
  21. 21 Canisius Wilhelmina Hospital, Nijmegen, Netherlands
  22. 22 Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, Netherlands
  23. 23 Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands
  24. 24 Department of Gastroenterology and Hepatology, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
  25. 25 Department of Radiology, St Antonius Hospital Location, Utrecht, Netherlands
  26. 26 Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
  27. 27 Department of Gastroenterology and Hepatology, St Antonius Hospital Location, Utrecht, Netherlands
  28. 28 Department of Surgery, University Medical Centre, Utrecht, Netherlands
  1. Correspondence to Hester C Timmerhuis, Department of Surgery, St Antonius Hospital Location Utrecht, Utrecht, Utrecht, Netherlands; h.timmerhuis{at}antoniusziekenhuis.nl

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.

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

Data availability statement

Data are available on reasonable request from the corresponding author.

https://doi.org/10.1136/gutjnl-2023-329735

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    Data availability statement

    Data are available on reasonable request from the corresponding author.

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    Footnotes

    • Twitter @marcbesselink

    • Contributors RAH performed the outpatient visits, RAH and HCT collected and entered all data, RAH and HCT verified all entered data. TLB reviewed all abdominal radiological images. RAH performed the statistical analysis. RAH and HCT drafted the manuscript. RAH, HCT, MGB, MB, PvD, E-JvG, MH, JH, SH, JEV-H, LMK, ERM, J-WP, RQ, TR, GPvdS, MPS, BWMS, MS, ACITLT, NGV, FV, RPV, RLJvW, TLB, RCV and HCvS coauthored the writing of the manuscript. All authors critically assessed the study design, included patients in the study, edited the manuscript and read and approved the final manuscript. RAH is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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