Feasibility of minimally invasive approaches in patients with infected necrotizing pancreatitis.

Contains fulltext : 52167.pdf (publisher's version ) (Closed access)BACKGROUND: Minimally invasive procedures to treat infected necrotizing pancreatitis (INP) are gaining popularity. The proportion of patients suitable for this approach remains unknown. METHODS: Preoperative computed tomography (CT) scans were reviewed from 106 consecutive patients who had surgery for INP between 2000 and 2003 in 11 Dutch hospitals. Collections related to the pancreas were classified according to their distance from the left abdominal wall. Five radiologists judged 'accessibility' for drain placement and the likelihood that there was a fluid component that would drain ('drainability'). Agreement between radiologists was determined. RESULTS: CT scans of 80 (75 per cent) patients were available (59 men; age range 29-80 years). The median interval between hospital admission and preoperative CT scan was 20 days. In 55 (69 per cent) patients, the lateral border of the collection was less than 5 cm from the left abdominal wall. Placement of a drain was deemed feasible in 67 (84 (range 77-89) per cent) patients; mean(s.d.) kappa 0.428(0.096). In 45 (56 per cent) patients, a drain could be placed through the left retroperitoneum. In 43 (54 (range 49-82) per cent) patients, collections were judged to contain a drainable fluid component. Interobserver agreement on 'drainability' was poor, mean(s.d.) kappa 0.289(0.101). CONCLUSION: Most peripancreatic collections in INP were considered accessible to a minimally invasive approach

Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness

Background: Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust. Methods: A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak® system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed. Results: Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was £111. Conclusions: This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres. © 2009 The Authors. Journal compilation © 2009 The British Dietetic Association Ltd