Optimizing invasive strategies for necrotizing pancreatitis: A Bayesian network analysis of randomized controlled...

Area of Science:

• Gastroenterology and Hepatology
• Surgical Critical Care
• Evidence-Based Medicine

Background:

• Necrotizing pancreatitis is a severe condition with high mortality and morbidity.
• Optimal timing and type of invasive interventions for necrotizing pancreatitis are uncertain.
• Systematic evaluation is needed to guide clinical decision-making in managing necrotizing pancreatitis.

Purpose of the Study:

• To systematically evaluate and compare the effectiveness of various invasive interventions for necrotizing pancreatitis.
• To identify optimal timing and types of procedures to reduce mortality and complications.
• To provide evidence-based guidance for managing patients with necrotizing pancreatitis.

Main Methods:

• Systematic review and Bayesian network meta-analysis adhering to PRISMA guidelines.
• Inclusion of randomized controlled trials (RCTs) published up to November 2024 from major databases.
• Assessment of 10 invasive interventions focusing on mortality and major complications using random-effects and Bayesian models.

Main Results:

• Fifteen RCTs with 857 patients were analyzed.
• Delayed step-up surgery (DSU) and early drainage with lavage (EDL) showed significant survival benefits and reduced complications.
• Delayed video-assisted surgery (DVS) was associated with the highest mortality; no significant differences between early drainage (ED) and EDL or ED and delayed drainage.

Conclusions:

• DSU and EDL appear promising for necrotizing pancreatitis, but evidence is inconclusive.
• Treatment strategies should be individualized due to varying risks, particularly with DVS.
• High-quality RCTs are required to strengthen evidence and inform clinical practice.