The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Early Versus Delayed Minimally Invasive 
Intervention for Infected Pancreatic 
Necrosis – A Systematic Review and Meta-
Analysis 
Ghazaleh S1*, Stanley S1, Renno A1, Karrick M1, Ramadugu A1, Aziz M1, Alastal Y1, 
Nawras A1

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: Sami.Ghazaleh@utoledo.edu

Published: 05 May 2023 

Introduction: Pancreatic necrosis complicates 20% of acute pancreatitis cases, and 30-40% of those 
become infected. Current guidelines recommend that invasive intervention for pancreatic necrosis 
should be delayed to 4 or more weeks from disease onset. However, recent studies have challenged the 
optimal timing of intervention. 

Methods: We conducted a systematic review and meta-analysis. We performed a comprehensive search 
in the databases of PubMed/MEDLINE, Embase, and the Cochrane from inception through April 11, 
2022. We collected the number of patients who underwent early and late interventions for infected 
pancreatic necrosis. Outcomes were mortality, gastrointestinal fistula or perforation, bleeding, and 
length of hospital stay. The random-effects model was used. A p value <0.05 was considered statistically 
significant. Heterogeneity was assessed using the Higgins I2 index.  

Results: Seven studies involving 742 patients were included in the meta-analysis. Timing of 
intervention had no statistically significant effect on mortality (RR 1.49, 95% CI 0.87 – 2.55, p = 0.15, 
I2 = 15%) or bleeding (RR 1.54, 95% CI 0.74 – 3.21, p = 0.24, I2 = 67%). However, early intervention 
was associated with a statistically significant higher risk of gastrointestinal fistula or perforation (RR 
1.52, 95% CI 1.04 – 2.21, p = 0.03, I2 = 0%) and a longer hospital length of stay (MD 10.25 days, 95% 
CI 0.41 – 20.10, p = 0.04, I2 = 52%).  

Discussion: Our meta-analysis demonstrated that the timing of intervention had no effect on mortality or 
bleeding. Early intervention resulted in higher risk of gastrointestinal fistula or perforation and longer 
length of stay. 

https://dx.doi.org/10.46570/utjms.vol11-2023-668 

https://dx.doi.org/10.46570/utjms.vol11-2023-668
mailto:Sami.Ghazaleh@utoledo.edu