Loveday Benjamin P T, Mittal Anubhav, Phillips Anthony, Windsor John A
Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
World J Surg. 2008 Nov;32(11):2383-94. doi: 10.1007/s00268-008-9701-y.
Minimally invasive techniques have been used to manage infected pancreatic necrosis and its local complications, although there are no randomised trials to evaluate these techniques. The aims of this study were to review the scope and quality of recommendations in current clinical practice guidelines on the role of percutaneous catheter drainage and endoscopic techniques for pancreatic abscess, pseudocyst, and infected pancreatic necrosis and identify the degree of consensus between guidelines.
A MEDLINE search was performed to identify current guidelines from any professional body published in the English language. Guidelines were analysed to determine their specific recommendations for using percutaneous catheter drainage and endoscopic techniques to manage pancreatic abscess, infected pseudocyst, and infected pancreatic necrosis.
Sixteen guidelines were reviewed. Percutaneous catheter drainage for pancreatic abscess was recommended by eight guidelines; for infected pseudocysts, one guideline did not recommend its use and six recommended its use; for infected necrosis, two guidelines did not recommend its use and four recommended its use. Endoscopic management of both pancreatic abscess and infected pseudocyst was recommended by seven guidelines; for infected necrosis, endoscopic management was recommended by ten guidelines. Ten guidelines did not include levels of evidence to support their recommendations.
Guidelines lacked consensus in their recommendations for minimally invasive management of pancreatic abscess, infected pseudocyst, and infected necrosis, and few recommendations were graded according to the strength of the evidence. More prospective trials are needed to provide evidence where it is lacking, which should be incorporated into clinical practice guidelines.
尽管尚无随机试验来评估这些技术，但微创技术已被用于处理感染性胰腺坏死及其局部并发症。本研究的目的是回顾当前临床实践指南中关于经皮导管引流和内镜技术在胰腺脓肿、假性囊肿及感染性胰腺坏死治疗中的作用的建议范围和质量，并确定各指南之间的共识程度。
进行MEDLINE检索，以识别以英文发表的任何专业机构的现行指南。对指南进行分析，以确定其关于使用经皮导管引流和内镜技术治疗胰腺脓肿、感染性假性囊肿及感染性胰腺坏死的具体建议。
共回顾了16项指南。八项指南推荐对胰腺脓肿进行经皮导管引流；对于感染性假性囊肿，一项指南不推荐使用，六项推荐使用；对于感染性坏死，两项指南不推荐使用，四项推荐使用。七项指南推荐对胰腺脓肿和感染性假性囊肿进行内镜治疗；对于感染性坏死，十项指南推荐内镜治疗。十项指南未纳入支持其建议的证据级别。
指南在胰腺脓肿、感染性假性囊肿及感染性坏死的微创治疗建议方面缺乏共识，且很少有建议根据证据强度进行分级。需要更多的前瞻性试验来提供缺乏证据的领域的证据，并应将其纳入临床实践指南。
