Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis
Lotte Boxhoorn1, Sven M van Dijk1, Janneke van Grinsven1
1From the Departments of Gastroenterology and Hepatology (L.B., P.F., R.P.V.), Surgery (S.M.D., J.G., M.A.B., M.F.G.F., M.G.B.), Radiology (M.P.M.K., K.P.L.), and Epidemiology and Data Science (M.G.W.D.), Amsterdam UMC, University of Amsterdam, and the Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam (M.A.J.M.J.), Amsterdam Gastroenterology Endocrinology Metabolism, and the Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis (J.M.J.), Amsterdam, the Departments of Research and Development (L.B., S.M.D., N.D.L.H., H.C.T.), Gastroenterology and Hepatology (R.C.V.), Radiology (T.L.B., K.P.L.), and Surgery (H.C.T., H.C.S.), St. Antonius Hospital, Nieuwegein, the Department of Surgery, Maastricht University Medical Center, Maastricht (S.A.W.B., C.H.C.D., M.P.), the Departments of Gastroenterology and Hepatology (M.J.B., J.-W.P.), and Surgery (C.H.J.E.), Erasmus MC University Medical Center, and the Department of Gastroenterology and Hepatology, Maasstad Hospital (M.H.), Rotterdam, the Departments of Radiology (V.C.C.), and Gastroenterology and Hepatology (T.E.H.R.), Jeroen Bosch Hospital, Den Bosch, the Department of Surgery, Gelre Hospitals, Apeldoorn (P.D.), the Department of Surgery, Radboud University Medical Center, Nijmegen (H.G., M.W.J.S.), the Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen (J.W.H.), the Department of Surgery, Medical Center Leeuwarden, Leeuwarden (E.R.M.), the Department of Surgery, Leiden University Medical Center, Leiden (J.S.D.M.), the Department of Surgery, University Medical Center Utrecht, Utrecht (I.Q.M., H.C.S.), the Departments of Surgery (V.B.N.), and Gastroenterology and Hepatology (A.C.P.), Isala Clinics, Zwolle, the Department of Gastroenterology and Hepatology, Reinier de Graaf Gasthuis, Delft (R.Q.), the Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort (M.P.S.), the Department of Gastroenterology and Hepatology, Amphia Hospital, Breda (T.C.S.), the Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven (J.W.A.S.), the Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede (N.G.V.), the Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht (W.V.), and the Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede (B.J.W.) - all in the Netherlands.
Early catheter drainage for infected necrotizing pancreatitis did not improve outcomes compared to delayed drainage. The postponed drainage strategy resulted in fewer invasive interventions for patients with infected necrotizing pancreatitis.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infectious Diseases
Background:
- Infected necrotizing pancreatitis is a life-threatening condition.
- Current treatment involves a step-up approach, often delaying catheter drainage until necrosis is encapsulated.
- The benefit of earlier drainage remains uncertain.
Purpose of the Study:
- To compare the efficacy of immediate versus postponed catheter drainage in patients with infected necrotizing pancreatitis.
- To evaluate the impact of drainage timing on complication rates.
- To assess the number of interventions required for each strategy.
Main Methods:
- A multicenter, randomized superiority trial was conducted.
- 104 patients with infected necrotizing pancreatitis were assigned to immediate (within 24 hours) or postponed drainage.
- The primary endpoint was the Comprehensive Complication Index score over 6 months.
Main Results:
- No significant difference in the Comprehensive Complication Index scores between immediate (57) and postponed (58) drainage groups (P=0.90).
- Mortality rates were similar: 13% for immediate and 10% for postponed drainage.
- The postponed drainage group required fewer interventions (2.6 vs. 4.4), with 39% avoiding drainage altogether.
Conclusions:
- Immediate drainage does not offer superiority over postponed drainage for infected necrotizing pancreatitis regarding complications.
- A postponed drainage strategy leads to fewer invasive interventions.
- This suggests a conservative approach may be beneficial for select patients.
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