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Objective: The aim of this study was to explore the incidence, risk factors, clinical course and treatment of perforation and fistula of the gastrointestinal (GI) tract in a large unselected cohort of patients with necrotizing pancreatitis.

Background: Perforation and fistula of the GI tract may occur in necrotizing pancreatitis. Data from large unselected patient populations on the incidence, risk factors, clinical outcomes, and treatment are lacking.

Methods: We performed a post hoc analysis of a nationwide prospective database of 896 patients with necrotizing pancreatitis. GI tract perforation and fistula were defined as spontaneous or iatrogenic discontinuation of the GI wall. Multivariable logistic regression was used to explore risk factors and to adjust for confounders to explore associations of the GI tract perforation and fistula on the clinical course.

Results: A perforation or fistula of the GI tract was identified in 139 (16%) patients, located in the stomach in 23 (14%), duodenum in 56 (35%), jejunum or ileum in 18 (11%), and colon in 64 (40%). Risk factors were high C-reactive protein within 48 hours after admission [odds ratio (OR): 1.19; 95% confidence interval (CI): 1.01-1.39] and early organ failure (OR: 2.76; 95% CI: 1.78-4.29). Prior invasive intervention was a risk factor for developing a perforation or fistula of the lower GI tract (OR: 2.60; 95% CI: 1.04-6.60). While perforation or fistula of the upper GI tract appeared to be protective for persistent intensive care unit-admission (OR: 0.11, 95% CI: 0.02-0.44) and persistent organ failure (OR: 0.15; 95% CI: 0.02-0.58), perforation or fistula of the lower GI tract was associated with a higher rate of new onset organ failure (OR: 2.47; 95% CI: 1.23-4.84). When the stomach or duodenum was affected, treatment was mostly conservative (n=54, 68%). Treatment was mostly surgical when the colon was affected (n=38, 59%).

Conclusions: Perforation and fistula of the GI tract occurred in one out of six patients with necrotizing pancreatitis. Risk factors were high C-reactive protein within 48 hours and early organ failure. Prior intervention was identified as a risk factor for perforation or fistula of the lower GI tract. The clinical course was mostly affected by involvement of the lower GI tract.

Competing Interests: The authors report no conflicts of interest.

Titel:	Perforation and Fistula of the Gastrointestinal Tract in Patients With Necrotizing Pancreatitis: A Nationwide Prospective Cohort.
Autor/in / Beteiligte Person:	Timmerhuis, HC ; van Dijk SM ; Hollemans, RA ; Umans, DS ; Sperna Weiland, CJ ; Besselink, MG ; Bouwense, SAW ; Bruno, MJ ; van Duijvendijk P ; van Eijck CHJ ; Issa, Y ; Mieog, JSD ; Molenaar, IQ ; Stommel, MWJ ; Bollen, TL ; Voermans, RP ; Verdonk, RC ; van Santvoort HC
Zeitschrift:	Annals of surgery, Jg. 278 (2023-08-01), Heft 2, S. e284-e292
Veröffentlichung:	Philadelphia, PA : Lippincott Williams & Wilkins, 2023
Medientyp:	academicJournal
ISSN:	1528-1140 (electronic)
DOI:	10.1097/SLA.0000000000005624
Schlagwort:	Humans C-Reactive Protein Disease Progression Upper Gastrointestinal Tract Fistula Pancreatitis Intestinal Perforation
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: Dutch Pancreatitis Study Group Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Ann Surg] 2023 Aug 01; Vol. 278 (2), pp. e284-e292. <i>Date of Electronic Publication: </i>2022 Jul 22. MeSH Terms: Upper Gastrointestinal Tract* ; Fistula* ; Pancreatitis* ; Intestinal Perforation* ; Humans ; C-Reactive Protein ; Disease Progression References: Forsmark CE, Swaroop Vege S, Wilcox CM. Acute pancreatitis. Campion EW, editor. N Engl J Med. 2016;375:1972–1981. ; O’Connor OJ, Buckley JM, Maher MM. Imaging of the complications of acute pancreatitis. Am J Roentgenol. 2011;197:W375–W381. ; van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet. 2018;391:51–58. ; Banks PA, Bollen TL, Dervenis C, et al. 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Perforation and Fistula of the Gastrointestinal Tract in Patients With Necrotizing Pancreatitis: A Nationwide Prospective Cohort.