Details

Autor(en) / Beteiligte

• Van Veldhuisen, Charlotte L
• Sissingh, Noor J
• Boxhoorn, Lotte
• van Dijk, Sven M
• van Grinsven, Janneke
• Verdonk, Robert C
• Boermeester, Marja A
• Bouwense, Stefan A W
• Bruno, Marco J
• Cappendijk, Vincent C
• van Duijvendijk, Peter
• van Eijck, Casper H J
• Fockens, Paul
• van Goor, Harry
• Hadithi, Muhammed
• Haveman, Jan Willem
• Jacobs, Maarten A J M
• Jansen, Jeroen M
• Kop, Marnix P M
• Manusama, Eric R
• Mieog, J Sven D
• Molenaar, I Quintus
• Nieuwenhuijs, Vincent B
• Poen, Alexander C
• Poley, Jan-Werner
• Quispel, Rutger
• Römkens, Tessa E H
• Schwartz, Matthijs P
• Seerden, Tom C
• Dijkgraaf, Marcel G W
• Stommel, Martijn W J
• Straathof, Jan Willem A
• Venneman, Niels G
• Voermans, Rogier P
• van Hooft, Jeanin E
• van Santvoort, Hjalmar C
• Besselink, Marc G

Titel

Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): Multicenter Randomized Trial

Ist Teil von

• Annals of surgery, 2024-04, Vol.279 (4), p.671

Ort / Verlag

United States

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis. In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention. Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications. Out of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33-2.28; P =0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56-7.37; P =0.34). The median number of additional interventions was 0 (IQR 0-0) in both groups ( P =0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P =0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar. Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach. ISRCTN33682933.