Pancreas
Gut. 2024;73(5):787–96
Long-term follow-up study of necrotising pancreatitis: Interventions, complications and quality of life
Objective: To describe the long-term consequences of necrotising pancreatitis, including complications, the need for interventions and the quality of life.
Design: Long-term follow-up of a prospective multicentre cohort of 373 necrotising pancreatitis patients (2005–2008) was performed. Patients were prospectively evaluated and received questionnaires. Readmissions (i.e., for recurrent or chronic pancreatitis), interventions, pancreatic insufficiency and quality of life were compared between initial treatment groups: conservative, endoscopic/percutaneous drainage alone and necrosectomy. Associations of patient and disease characteristics during index admission with outcomes during follow-up were assessed.
Results: During a median follow-up of 13.5 years (range, 12–15.5 years), 97 of 373 patients (26%) were readmitted for recurrent pancreatitis. Endoscopic or percutaneous drainage was performed in 47 of 373 patients (13%), of whom 21 of 47 patients (45%) were initially treated conservatively. Pancreatic necrosectomy or pancreatic surgery was performed in 31 of 373 patients (8%), without differences between treatment groups. Endocrine insufficiency (126/373 patients; 34%) and exocrine insufficiency (90/373 patients; 38%), developed less often following conservative treatment (p < 0.001 and p = 0.016, respectively). Quality of life scores did not differ between groups. Pancreatic gland necrosis > 50% during initial admission was associated with percutaneous/endoscopic drainage (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 1.5–12.2), pancreatic surgery (OR = 3.2; 95% CI: 1.1–9.5) and development of endocrine insufficiency (OR = 13.1; 95% CI: 5.3–32.0) and exocrine insufficiency (OR = 6.1; 95% CI: 2.4–15.5) during follow-up.
Conclusion: Acute necrotising pancreatitis carries a substantial disease burden during long-term follow-up in terms of recurrent disease, the necessity for interventions and development of pancreatic insufficiency, even when treated conservatively during the index admission. Extensive (> 50%) pancreatic parenchymal necrosis seems to be an important predictor of interventions and complications during follow-up.