Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial

Abstract

The Dutch Digestive Disease Foundation, Fonds NutsOhra, and the Netherlands Organization for Health Research and Development.

Comparison of endoscopic and percutaneous drainage of symptomatic necrotic collections in acute necrotizing pancreatitis

“…The mortality rate of 9.4% is comparable to that of contemporary studies, which range from 7% to 25% . All patient deaths in our series were unrelated to their procedures.…”

Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections

“…5,6 If expertise is available, endoscopic drainage of symptomatic PFCs that abut the stomach or duodenum is preferred to percutaneous or surgical approaches. 7–9 Percutaneous drainage carries the risk of pancreaticocutaneous fistula formation in up to 14% of patients. 10–12 Surgical approaches have high morbidity (25%) and mortality (5%).…”

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

“…In the step-up approach, nearly half of the patients can be treated with drainages alone, the other half require additional different procedures for the final treatment, including percutaneous, endoscopic, open, or minimally invasive surgery [17, 50, 52, 53]. In a systematic review including 10 retrospective series and one RCT with 384 patients who underwent percutaneous drainage because of acute necrotizing pancreatitis, percutaneous drainage was sufficient as definitive treatment in 56% of patients [54].…”

“…Compared to surgical necrosectomy, an endoscopic approach significantly reduces proinflammatory response and improves clinical outcome in ANP patients [52]. However, when used as a single modality approach, it requires more sessions of necrosectomy for definitive treatment than in combination with other interventional procedures [53, 61-63]. A large meta-analysis found that endoscopic necrosectomy has success rate of 81% as a single treatment modality with a complication rate of 36% [64].…”

“…In the largest randomized controlled trial, comparing endoscopic step-up approach with surgical step-up approach [53], both procedures have similar mortality rates and major complications. The surgical step-up approach, however, had a higher incidence of pancreatocutaneous fistula [51, 53]. …”