Endoscopic Versus Surgical Step-Up Approach for Infected Necrotizing Pancreatitis (ExTENSION): Long-term Follow-up of
Anke M Onnekink1, Lotte Boxhoorn1, Hester C Timmerhuis2
1Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Amsterdam, the Netherlands; Department of Research and Development, St. Antonius Hospital, Nieuwegein, the Netherlands.
Gastroenterology
|May 17, 2022
Summary
Long-term follow-up of infected necrotizing pancreatitis shows endoscopic and surgical step-up approaches have similar rates of death and major complications. However, endoscopy led to fewer fistulas and reinterventions.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Pancreatic Diseases
Background:
- Previous trials suggested endoscopic step-up approach (ESUA) may be preferred over surgical step-up approach (SSUA) for infected necrotizing pancreatitis (INP).
- Short-term outcomes favored ESUA, but long-term data were lacking.
Purpose of the Study:
- To compare long-term clinical outcomes (≥5 years) of ESUA versus SSUA in patients with INP.
- To assess mortality, major complications, pancreatic fistulas, reinterventions, pancreatic insufficiency, and quality of life.
Main Methods:
- Long-term follow-up of 83 patients from the TENSION trial (mean follow-up: 7 years).
- Primary endpoint: composite of death and major complications.
- Secondary endpoints: pancreaticocutaneous fistula, reinterventions, pancreatic insufficiency, quality of life.
Main Results:
- No significant difference in the primary endpoint between ESUA and SSUA (53% vs 57%, RR 0.93).
- ESUA group had fewer pancreaticocutaneous fistulas (8% vs 34%, RR 0.23).
- ESUA group required fewer reinterventions post-6 months (7% vs 24%, RR 0.29).
Conclusions:
- Long-term, ESUA is not superior to SSUA for death or major complications in INP.
- ESUA is associated with reduced pancreatic fistulas and reinterventions.
- Pancreatic insufficiency and quality of life did not differ between approaches.
Related Concept Videos
01:29Chronic Pancreatitis II: Collaborative Care
133
The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Assessment:
133
01:26Endoscopic Procedures V: ERCP
1.0K
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
1.0K