When someone has a dangerously inflamed pancreas, doctors often operate to cut away dead tissue that contributes to the problem. A new study suggests that minimal surgery may be better.
A more gradual approach — first draining pus from the pancreas and later surgically removing loose tissue, if necessary — produces fewer complications without increasing the risk of death, doctors in the Netherlands reported in the New England Journal of Medicine.
Adopting the step-by-step treatment in the United States, where about 233,000 people are hospitalized with acute pancreatitis each year, would save about $185 million annually in health costs, said the team, led by Dr. Hjalmar van Santvoort of University Medical Center Utrecht.
The pancreas produces insulin and chemicals to help digest food. It can become inflamed by excessive alcohol consumption, gallstones, and other factors.
But in as many as 20 percent of the cases, the inflammation can become severe and lead to a condition known as necrotizing pancreatitis. When that happens, the risk of death is high.
The standard treatment is to cut out the dead tissue. But that increases the risk of diabetes and other problems, because it can be difficult to see where the dead tissue ends and the normal tissue begins, Van Santvoort said in a telephone interview.
"And when you remove necrotic tissue, you have to pull it away from viable tissue and the viable pancreatic tissue may be damaged and start to bleed. So even if you're very careful, it's a very difficult procedure," he said.
The new study, involving 88 volunteers, was designed to see if a series of less extreme steps would be as effective.
The researchers found the rate of major complications was 69 percent for patients who had surgery right away.
Among those who had pus drained as the first step in treatment, followed by less aggressive surgery if necessary, the complication rate was 40 percent.
The initial step is an easy technique that any radiologist can perform and it leaves more healthy insulin-producing cells so patients are less likely to develop diabetes, Van Santvoort said.
In the new study, only 16 percent of the patients receiving step-up care developed diabetes soon after treatment compared to 38 percent who had traditional surgery.
The death rate in both groups was about the same.
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