HEPATOBILIARY-PANCREAS Larger bore percutaneous catheter in necrotic pancreatic fluid collection is associated with better outcomes Pankaj Gupta 1 & Akash Bansal 1 & Jayanta Samanta 2 & Harshal Mandavdhare 2 & Vishal Sharma 2 & Vikas Gupta 3 & Thakur Deen Yadav 3 & Usha Dutta 2 & Rakesh Kochhar 2 & Manavjit Singh Sandhu 1 Received: 31 July 2020 /Revised: 3 September 2020 /Accepted: 12 October 2020 # European Society of Radiology 2020 Abstract Objective To evaluate the impact of initial catheter size on the clinical outcomes in acute pancreatitis (AP). Methods This retrospective study comprised consecutive patients with AP who underwent percutaneous catheter drainage (PCD) between January 2018 and May 2019. Three hundred fifteen consecutive patients underwent PCD during the study period. Based on the initial catheter size, patients were divided into group I (≤ 12 F) and group II (> 12 F). The differences in the clinical outcomes between the two groups, as well as multiple subgroups (based on the severity, timing of drainage, and presence of organ failure (OF)), were evaluated. Results One hundred forty-six patients (mean age, 41.2 years, 114 males) fulfilled the inclusion criteria. Ninety-nine (67.8%) patients had severe AP based on revised Atlanta classification. The mean pain to PCD was 22 days (range, 3–267 days). Mean length of hospitalization (LOH) was 27.9 ± 15.8 days. Necrosectomy was performed in 20.5% of patients, and mortality was 16.4%. Group I and II comprised 74 and 72 patients, respectively. There was no significant difference in baseline characteristics, except for a greater number of patients with OF in group II (p = 0.048). The intensive care unit stay was significantly shorter, and multiple readmissions were less frequent in group II ( p = 0.037 and 0.013, respectively). Patients with severe AP and moderately severe AP in group II had significantly reduced rates of readmissions ( p = 0.035) and significantly shorter LOH (p = 0.041), respectively. Conclusion Large-sized catheters were associated with better clinical outcomes regardless of disease severity and other baseline disease characteristics. Key Points • Larger catheter size for initial PCD was associated with better clinical outcomes in AP. • The benefits were independent of the severity of AP, timing of PCD (ANC vs. WON) and presence of organ failure. Keywords Acute necrotizing pancreatitis . Drainage . Catheters Abbreviations ANC Acute necrotic collection AP Acute pancreatitis CT Computed tomography ICU Intensive care unit LOH Length of hospitalization mCTSI Modified CT severity index OF Organ failure PCD Percutaneous catheter drainage PFC Pancreatic fluid collection RAC Revised Atlanta classification WON Walled-off necrosis Introduction Acute pancreatitis (AP) is a heterogeneous disease com- prising patients with varying disease severity and necro- sis that is limited to the pancreas or extending into * Pankaj Gupta Pankajgupta959@gmail.com 1 Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India 2 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India 3 Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India European Radiology https://doi.org/10.1007/s00330-020-07411-6