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May 11, 2022 8 tweets 6 min read Read on X
1/ It's #EBGI Tweetorial 🧵 w/ @aileenbui!

“Drainage for Infected Pancreatic Necrosis – Earlier Is Not Better"

📜 Summary: bit.ly/3kONaEQ
📰 in @NEJM: bit.ly/3MWe4X5

@SunilAminMD @KumarShria
@MarcBesselink @pancreatitis_nl
#GITwitter #MedTwitter
2/ Let’s start with a poll:

40 yo 🙎🏻‍♂️ w/ worsening signs of sepsis 14 days after initial dx of acute pancreatitis. CT A/P w/ gas in the area of pancreatic necrosis.

What do you do?
3/ Importance

🔸1/3 of pancreatic necrosis ➡️ infected (after ~10 days)
🔸Infection 🦠 ➡️ 20-30% mortality
🔸Management is usually step⬆️, see 👇
🔸But, the timing of catheter drainage is unclear
4/ 🔎 Design

📍RCT in 🇳🇱
📍Patients 👥 with infected necrosis
📍Randomized to immediate vs delayed drainage
📍If clinical decompensation ➡️ drain earlier
📍If drainage fails ➡️✂️
📍All 👥 received abx immediately after dx of 🦠
📍Primary outcome: Comprehensive Complication Index
5/ 🔎findings

✳️ No difference in the Comprehensive Complication Index
✳️ No difference in mortality and organ failure
✳️ No difference in cost or length of stay
✳️ ⬇️ interventions in postponed drainage group
✳️ 40% of postponed drainage group treated w/ abx alone
@gooreducatie
6/ ⚠️Caution⚠️

❗️37 👥 died prior to randomization
❗️🕑 drainage after symptom onset: 24 days (immediate) vs 34 days (delayed)
❗️Postponed drainage may not be suitable for all 👥
❗️Trial excluded 👥 where drainage was unfeasible
❗️Trial evaluated🕑 of intervention, not method
7/ My Practice
@SunilAminMD @KumarShria
✅ Abx that penetrate necrosis in all 👥
✅ Delay drainage until collection walled off (~ 4 weeks)
✅ Endoscopic approach 1st, unless ❌ location or <4wks from pancreatitis onset
✅ Percutaneous drainage if endoscopic approach not possible
8/ Thank you! Check us out at gi.org/ebgi

We post weekly #EBGI summaries on Wednesday 6-7 PM EST

Next week's⭐️moderators @RaoMujtabaAfza1 @noorannemd have a special "in case you missed it" edition!

Any articles you'd like us to review? 📨 @JosephHabibi_MD

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More from @AmCollegeGastro

Jun 7, 2021
Time to register for #ACG2021 Annual Scientific Mtg & Postgrad Course!

Reconnect.
Renew Friendships.
Refresh Your Knowledge.

➡️acgmeetings.gi.org

Things we forward to LIVE & IN-PERSON:

‼️ Seeing colleagues in #GIcommunity‼️

#Gastroenterology #GItwitter #ACGfamily
#ACG2021 It's time to sign up!
ACG Annual Scientific Mtg & Postgrad Course

➡️acgmeetings.gi.org

Things we look forward to LIVE & IN-PERSON:

‼️World-class clinical education‼️

#Gastroenterology #GIcommunity #ACGfamily #GItwitter
#ACG2021 Registration is open!
ACG Annual Scientific Mtg & Postgrad Course

➡️acgmeetings.gi.org

Things we look forward to LIVE & IN-PERSON:

‼️Celebrating & uplifting #DiversityinGI‼️ #DiversityEquityandInclusion

#GIcommunity #ACGfamily #GItwitter
Read 11 tweets
Jun 6, 2021
ICYMI: ACG has monthly Virtual Grand Rounds on career-focused topics
See the 🧵below for past webinars!

Join us for the next VGR
High Yield Tips for Billing in Clinic & Endoscopy
Wed, June 16 @ 8:30pm EDT
👉gi.org/career-focused…
ACG Virtual Grand Rounds: Career Edition
Work Life Balance

👉gi.org/career-focused…
ACG Virtual Grand Rounds: Career Edition
Networking and Social Media

👉gi.org/career-focused…
Read 4 tweets

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