Management of acute pancreatitis in Japan: Analysis of nationwide epidemiological survey

Shin Hamada, Atsushi Masamune, Tooru Shimosegawa

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)

Abstract

Acute pancreatitis (AP) is an acute inflammatory disease of the exocrine pancreas. In Japan, nationwide epidemiological surveys have been conducted every 4 to 5 years by the Research Committee of Intractable Pancreatic Diseases, under the support of the Ministry of Health, Labour, and Welfare of Japan. We reviewed the results of the nationwide surveys focusing on the severity assessment and changes in the therapeutic strategy for walled-off necrosis. The severity assessment system currently used in Japan consists of 9 prognostic factors and the imaging grade on contrastenhanced computed tomography. By univariate analysis, all of the 9 prognostic factors were associated with AP-related death. A multivariate analysis identified 4 out of the 9 prognostic factors (base excess or shock, renal failure, systemic inflammatory response syndrome criteria, and age) that were associated with AP-related death. Receiver-operating characteristics curve analysis showed that the area under the curve was 0.82 for these 4 prognostic factors and 0.84 for the 9 prognostic factors, suggesting the comparable utility of these 4 factors in the severity assessment. We also examined the temporal changes in treatment strategy for walled-off necrosis in Japan according to the 2003, 2007, and 2011 surveys. Step-up approaches and lessinvasive endoscopic therapies were uncommon in 2003 and 2007, but became popular in 2011. Mortality has been decreasing in patients who require intervention for walled-off necrosis. In conclusion, the nationwide survey revealed the comparable utility of 4 prognostic factors in the severity assessment and the increased use of less-invasive, step-up approaches with improved clinical outcomes in the management of walled-off necrosis.

Original languageEnglish
Pages (from-to)6335-6344
Number of pages10
JournalWorld Journal of Gastroenterology
Volume22
Issue number28
DOIs
Publication statusPublished - 2016 Jul 28

Keywords

  • Diagnostic criteria
  • Endoscopic necrosectomy
  • Epidemiology
  • Pancreatic pseudocyst
  • Step-up approach
  • Systemic inflammatory response syndrome
  • Walled-off necrosis

ASJC Scopus subject areas

  • Gastroenterology

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