Efficacy and safety of early abdominal paracentesis drainage in patients with severe acute pancreatitis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Zhangpeng ^1,2 , WANG Xuyang ^1,3 , HUANG Dongxin ^1,4 , LUO Huanhuan ^1,4 , JING Guangxu ^1,2 , SUN Hongyu ^1,5 ,  TANG Lijun ^1,2

1. PLA Center of General Surgery, Pancreatic Injury and Repair Key Laboratory of Sichuan Province, the General Hospital of Western Theater Command, Chengdu 610083, P. R. China;
2. College of Medicine, Southwest Medical University, Luzhou 646000, P. R. China;
3. College of Medicine, Chongqing Medical University, Chongqing 400016, P. R. China;
4. College of Medicine, Southwest Jiaotong University, Chengdu 610063, P. R. China;
5. Basic Medical Laboratory, the General Hospital of Western Theater Command, Chengdu 610083, P. R. China;

Corresponding?author：

TANG Lijun, Email: tanglj2016@163.com

Keywords：

Severe acute pancreatitis; Abdominal paracentesis drainage; Therapeutic effect; Meta-analysis

DOI：

10.7507/1672-2531.202212044

Video：

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Objective To systematically review the efficacy and safety of early abdominal paracentesis drainage (APD) in patients with severe acute pancreatitis (SAP). Methods The PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials and cohort studies on the management of SAP via early APD from inception to December 10, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software and Stata 17.0 software. Results Eighteen studies were included, with a total sample size of 2 685 patients. The meta-analysis showed that early APD could decrease mortality (OR=0.49, 95%CI 0.35 to 0.69, P<0.01) and the incidences of multiple organ failure (OR=0.56, 95%CI 0.45 to 0.71, P<0.01), ARDS (OR=0.54, 95%CI 0.41 to 0.71, P<0.01), and infectious complications (OR=0.72, 95%CI 0.57 to 0.92, P<0.01) and also reduce the need for further interventions and the total cost incurred during hospitalization, reduce the length of hospital stay, and reduce the number of days spent in the intensive care unit. However, there were no significant differences in the incidence of pneumonia, bacteremia, and sepsis between the two groups. Conclusion The treatment of SAP via early APD, which has high clinical value, could decrease the incidence of multiple organ failure, improve the prognosis of patients, and reduce the associated mortality rate. Moreover, APD does not increase the risk of infection-related complications. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： WANG Zhangpeng, WANG Xuyang, HUANG Dongxin, LUO Huanhuan, JING Guangxu, SUN Hongyu, TANG Lijun. Efficacy and safety of early abdominal paracentesis drainage in patients with severe acute pancreatitis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(3): 292-297. doi: 10.7507/1672-2531.202212044 Copy

1.	Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA, 2021, 325(4): 382-390.
2.	Bush N, Rana SS. Ascites in acute pancreatitis: clinical implications and management. Dig Dis Sci, 2022, 67(6): 1987-1993.
3.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
4.	Besselink MG, van Santvoort HC, Bakker OJ, et al. Draining sterile fluid collections in acute pancreatitis. primum non nocere! Surg Endosc, 2011, 25(1): 331-332.
5.	Samanta J, Rana A, Dhaka N, et al. Ascites in acute pancreatitis: not a silent bystander. Pancreatology, 2019, 19(5): 646-652.
6.	Zeng QX, Wu ZH, Huang DL, et al. Association between ascites and clinical findings in patients with acute pancreatitis: a retrospective study. Med Sci Monit, 2021, 27: e933196.
7.	Yang E, Nguyen NH, Kwong WT. Abdominal free fluid in acute pancreatitis predicts necrotizing pancreatitis and organ failure. Ann Gastroenterol, 2021, 34(6): 872-878.
8.	蘇江林, 胡斌. 急性胰腺炎相關性腹腔積液研究進展. 中國實用外科雜志, 2022, 42(9): 1058-1061.
9.	Huang Z, Yu SH, Liang HY, et al. Outcome benefit of abdominal paracentesis drainage for severe acute pancreatitis patients with serum triglyceride elevation by decreasing serum lipid metabolites. Lipids Health Dis, 2016, 15: 110.
10.	Liu WH, Ren LN, Chen T, et al. Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits patients attacked by acute pancreatitis with fluid collections: a retrospective clinical cohort study. Crit Care Med, 2015, 43(1): 109-119.
11.	Zerem E, Kunosi? S, Zerem D, et al. Benefits of abdominal paracentesis drainage performed ahead of percutaneous catheter drainage as a modification of the step-up approach in acute pancreatitis with fluid collections. Acta Gastroenterol Belg, 2020, 83(2): 285-293.
12.	Zerem E, Jusufovi? R, Handanagi? A, et al. Is abdominal paracentesis drainage too risky for patients with severe acute pancreatitis. J Clin Gastroenterol, 2016, 50(2): 182-183.
13.	McGrath S, Zhao X, Steele R, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res, 2020, 29(9): 2520-2537.
14.	Li H, Wu Y, Xu C, et al. Early ultrasound-guided percutaneous catheter drainage in the treatment of severe acute pancreatitis with acute fluid accumulation. Exp Ther Med, 2018, 16(3): 1753-1757.
15.	Hongyin L, Zhu H, Tao W, et al. Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: a randomized controlled trial. Scand J Gastroenterol, 2017, 52(4): 389-395.
16.	Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
17.	Wen Y, Zhuo WQ, Liang HY, et al. Abdominal paracentesis drainage improves outcome of acute pancreatitis complicated with intra-abdominal hypertension in early phase. Am J Med Sci, 2023, 365(1): 48-55.
18.	Zhou J, Huang Z, Cheng L, et al. Abdominal paracentesis drainage (APD) attenuates acute pancreatitis-associated lung injury in patients with ascitic fluids: a retrospective study. Inter J Clin Experi Med, 2016, 9(9): 18400-18409.
19.	曾繁林, 林潔, 謝雨林, 等. 腹腔穿刺引流療法治療伴有腹腔積液重癥急性胰腺炎的臨床觀察. 當代醫學, 2017, 23(25): 132-134.
20.	李盈, 劉明輝, 王國濤, 等. 超聲引導經皮腹膜后穿刺置管引流前腹腔穿刺引流治療重癥急性胰腺炎. 中國介入影像與治療學, 2018, 15(11): 670-673.
21.	羅文婷, 譚碧君, 甘田, 等. 超聲引導經皮腹膜后穿刺置管引流前腹腔穿刺引流治療重癥急性胰腺炎的臨床價值. 臨床外科雜志, 2019, 27(5): 412-415.
22.	馬軍偉,盧啟國. 急性胰腺炎合并液體積聚患者在經皮穿刺置管引流前行腹腔穿刺引流治療效果探討. 現代消化及介入診療, 2017, 22(1): 110-113.
23.	宋佳財, 唐藝, 蔡龍, 等. 急性重癥胰腺炎早期行腹腔穿刺置管引流的價值分析. 中國當代醫藥, 2021, 28(35): 40-42,46.
24.	蘇江林, 黃竹, 孫紅玉, 等. 腹腔引流穿刺時機對重癥急性胰腺炎患者預后的影響. 中華肝膽外科雜志, 2018, 24(10): 692-697.
25.	陶偉, 昝建寶, 宋康頡, 等. 腹腔穿刺引流時機對中度重癥急性胰腺炎預后的影響. 醫學信息, 2022, 35(7): 137-140.
26.	詹蘇東, 彭濤, 陶京, 等. 早期腹腔穿刺引流治療重癥急性胰腺炎. 中華普通外科雜志, 2012, 27(9): 717-720.
27.	張亮, 嚴智文, 魏亮, 等. 超聲引導下經皮腹膜后穿刺置管引流前先行腹腔穿刺引流對重癥胰腺炎的應用價值探討. 中國醫刊, 2020, 55(4): 394-398.
28.	張星城, 孫昀, 余維麗, 等. 早期腹腔穿刺引流在重癥急性胰腺炎治療中的應用價值. 中華肝膽外科雜志, 2021, 27(8): 599-603.
29.	楊熊, 劉若鴻, 謝川, 等. 早期腹腔穿刺引流對重癥急性胰腺炎腎損傷的保護作用. 中國普通外科雜志, 2021, 30(3): 321-329.
30.	Lu Z, Zhu X, Hua T, et al. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open, 2021, 11(8): e045031.

1. Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA, 2021, 325(4): 382-390.
2. Bush N, Rana SS. Ascites in acute pancreatitis: clinical implications and management. Dig Dis Sci, 2022, 67(6): 1987-1993.
3. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
4. Besselink MG, van Santvoort HC, Bakker OJ, et al. Draining sterile fluid collections in acute pancreatitis. primum non nocere! Surg Endosc, 2011, 25(1): 331-332.
5. Samanta J, Rana A, Dhaka N, et al. Ascites in acute pancreatitis: not a silent bystander. Pancreatology, 2019, 19(5): 646-652.
6. Zeng QX, Wu ZH, Huang DL, et al. Association between ascites and clinical findings in patients with acute pancreatitis: a retrospective study. Med Sci Monit, 2021, 27: e933196.
7. Yang E, Nguyen NH, Kwong WT. Abdominal free fluid in acute pancreatitis predicts necrotizing pancreatitis and organ failure. Ann Gastroenterol, 2021, 34(6): 872-878.
8. 蘇江林, 胡斌. 急性胰腺炎相關性腹腔積液研究進展. 中國實用外科雜志, 2022, 42(9): 1058-1061.
9. Huang Z, Yu SH, Liang HY, et al. Outcome benefit of abdominal paracentesis drainage for severe acute pancreatitis patients with serum triglyceride elevation by decreasing serum lipid metabolites. Lipids Health Dis, 2016, 15: 110.
10. Liu WH, Ren LN, Chen T, et al. Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits patients attacked by acute pancreatitis with fluid collections: a retrospective clinical cohort study. Crit Care Med, 2015, 43(1): 109-119.
11. Zerem E, Kunosi? S, Zerem D, et al. Benefits of abdominal paracentesis drainage performed ahead of percutaneous catheter drainage as a modification of the step-up approach in acute pancreatitis with fluid collections. Acta Gastroenterol Belg, 2020, 83(2): 285-293.
12. Zerem E, Jusufovi? R, Handanagi? A, et al. Is abdominal paracentesis drainage too risky for patients with severe acute pancreatitis. J Clin Gastroenterol, 2016, 50(2): 182-183.
13. McGrath S, Zhao X, Steele R, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res, 2020, 29(9): 2520-2537.
14. Li H, Wu Y, Xu C, et al. Early ultrasound-guided percutaneous catheter drainage in the treatment of severe acute pancreatitis with acute fluid accumulation. Exp Ther Med, 2018, 16(3): 1753-1757.
15. Hongyin L, Zhu H, Tao W, et al. Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: a randomized controlled trial. Scand J Gastroenterol, 2017, 52(4): 389-395.
16. Liu L, Yan H, Liu W, et al. Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. J Clin Gastroenterol, 2015, 49(9): 757-763.
17. Wen Y, Zhuo WQ, Liang HY, et al. Abdominal paracentesis drainage improves outcome of acute pancreatitis complicated with intra-abdominal hypertension in early phase. Am J Med Sci, 2023, 365(1): 48-55.
18. Zhou J, Huang Z, Cheng L, et al. Abdominal paracentesis drainage (APD) attenuates acute pancreatitis-associated lung injury in patients with ascitic fluids: a retrospective study. Inter J Clin Experi Med, 2016, 9(9): 18400-18409.
19. 曾繁林, 林潔, 謝雨林, 等. 腹腔穿刺引流療法治療伴有腹腔積液重癥急性胰腺炎的臨床觀察. 當代醫學, 2017, 23(25): 132-134.
20. 李盈, 劉明輝, 王國濤, 等. 超聲引導經皮腹膜后穿刺置管引流前腹腔穿刺引流治療重癥急性胰腺炎. 中國介入影像與治療學, 2018, 15(11): 670-673.
21. 羅文婷, 譚碧君, 甘田, 等. 超聲引導經皮腹膜后穿刺置管引流前腹腔穿刺引流治療重癥急性胰腺炎的臨床價值. 臨床外科雜志, 2019, 27(5): 412-415.
22. 馬軍偉,盧啟國. 急性胰腺炎合并液體積聚患者在經皮穿刺置管引流前行腹腔穿刺引流治療效果探討. 現代消化及介入診療, 2017, 22(1): 110-113.
23. 宋佳財, 唐藝, 蔡龍, 等. 急性重癥胰腺炎早期行腹腔穿刺置管引流的價值分析. 中國當代醫藥, 2021, 28(35): 40-42,46.
24. 蘇江林, 黃竹, 孫紅玉, 等. 腹腔引流穿刺時機對重癥急性胰腺炎患者預后的影響. 中華肝膽外科雜志, 2018, 24(10): 692-697.
25. 陶偉, 昝建寶, 宋康頡, 等. 腹腔穿刺引流時機對中度重癥急性胰腺炎預后的影響. 醫學信息, 2022, 35(7): 137-140.
26. 詹蘇東, 彭濤, 陶京, 等. 早期腹腔穿刺引流治療重癥急性胰腺炎. 中華普通外科雜志, 2012, 27(9): 717-720.
27. 張亮, 嚴智文, 魏亮, 等. 超聲引導下經皮腹膜后穿刺置管引流前先行腹腔穿刺引流對重癥胰腺炎的應用價值探討. 中國醫刊, 2020, 55(4): 394-398.
28. 張星城, 孫昀, 余維麗, 等. 早期腹腔穿刺引流在重癥急性胰腺炎治療中的應用價值. 中華肝膽外科雜志, 2021, 27(8): 599-603.
29. 楊熊, 劉若鴻, 謝川, 等. 早期腹腔穿刺引流對重癥急性胰腺炎腎損傷的保護作用. 中國普通外科雜志, 2021, 30(3): 321-329.
30. Lu Z, Zhu X, Hua T, et al. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open, 2021, 11(8): e045031.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of early abdominal paracentesis drainage in patients with severe acute pancreatitis: a meta-analysis

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