An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for...

Area of Science:

• Gastroenterology and Hepatology
• Surgical Innovation
• Clinical Trials

Background:

• Infected necrotizing pancreatitis presents a significant clinical challenge with high morbidity and mortality.
• Treatment has evolved from open necrosectomy to less invasive methods.
• Comparing minimally invasive surgery with endoscopic interventions is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the efficacy and safety of minimally invasive surgery versus endoscopic approaches for infected necrotizing pancreatitis.
• To evaluate key clinical endpoints including major complications, mortality, and quality of life.
• To assess the economic impact of each intervention strategy.

Main Methods:

• A single-center randomized trial involving 66 patients with infected necrotizing pancreatitis requiring intervention.
• Patients were randomized to either minimally invasive surgery (n=32) or an endoscopic step-up approach (n=34).
• The primary endpoint was a composite of major complications or death within 6 months.

Main Results:

• The endoscopic approach resulted in significantly fewer major complications (11.8% vs 40.6%) compared to minimally invasive surgery.
• No significant difference in mortality was observed between the groups (endoscopy 8.8% vs surgery 6.3%).
• The endoscopic group showed a significant reduction in fistulae formation (0% vs 28.1%), improved quality of life, and lower mean total costs.

Conclusions:

• Endoscopic transluminal intervention is superior to minimally invasive surgery for infected necrotizing pancreatitis, reducing major complications.
• The endoscopic approach offers improved quality of life and cost-effectiveness.
• This study supports the endoscopic step-up approach as a preferred strategy for managing infected necrotizing pancreatitis.