Rounded Rectangles

Staged multidisciplinary step-up management for necrotizingpancreatitisD. W. da Costa1, D. Boerma2, H. C. van Santvoort2, K. D. Horvath6, J. Werner7, C. R. Carter8,T. L. Bollen3, H. G. Gooszen1, M. G. Besselink4 and O. J. Bakker51Department of Operating Theatres and Evidence Based Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, Departments of 2Surgeryand 3Radiology, St Antonius Hospital, Nieuwegein, 4Department of Surgery, Academic Medical Centre, Amsterdam, and 5Department of Surgery,University Medical Centre Utrecht, Utrecht, The Netherlands, 6Department of Surgery, University of Washington Medical Center, Seattle,Washington, USA, 7Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany, and 8Department of Surgery, Glasgow RoyalInfirmary, Glasgow, UKCorrespondence to: Mr O. J. Bakker, Department of Surgery, HP G04.228, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.

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International Association of Pancreatology/ American Pancreatic Association / American Gastroenterological Association. , .

CATEGORYCHARACTERISTICS

MILDNo organ failure,no local or systemic complications

MODERATEOrgan failure for less than 48hrs or local or other systemic complications

SEVEREOrgan failure for more than 48 hrs local or other systemic complications usually present

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sensitivityspecificityPositive predictive valueoverall

Cholecystolithiasis u/shighmoderateexcellenthigh

Choledocholithiasis u/spoorhighmoderatemoderate

EUSexcellentexcellentexcellentexcellent

MRCPexcellentexcellentexcellentexcellent

CECThighhighhighhigh

Poor ( 60%) moderate (60 74%) high (74 90%) excellent (91 100%)

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, , . , Modified Glascow, Ranson APACHE (acute physiology and chronic health evaluation) , . 93%. BUN (Blood Urea Nitrogen) .BUN 20mg/l (7,14mol/l) 24, .

, SIRS , MRI CT , SIRS , . , , 40-78%

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ACS

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-PCD (percutaneous catheter drainage)

, . FNA 2 3 , PCD. PCD, , - . , PCD , 35- 55 % , ., PCD.

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