Immediate or postponed drainage has similar outcomes in Infected Necrotizing Pancreatitis: NEJM

Infected necrotizing pancreatitis is a potentially lethal disease that is treated with the use of a step-up approach, with catheter drainage often delayed until the infected necrosis is encapsulated. Whether outcomes could be improved by earlier catheter drainage is unknown.

The researchers conducted a multicenter, randomized superiority trial involving patients with infected necrotizing pancreatitis, in which we compared immediate drainage within 24 hours after randomization once infected necrosis was diagnosed with drainage that was postponed until the stage of walled-off necrosis was reached. The primary endpoint was the score on the Comprehensive Complication Index, which incorporates all complications over the course of 6 months of follow-up.

The results of the study are as follows:

· A total of 104 patients were randomly assigned to immediate drainage (55 patients) or postponed drainage (49 patients).

· The mean score on the Comprehensive Complication Index (scores range from 0 to 100, with higher scores indicating more severe complications) was 57 in the immediate-drainage group and 58 in the postponed-drainage group.

· Mortality was 13% in the immediate-drainage group and 10% in the postponed-drainage group.

· The mean number of interventions (catheter drainage and necrosectomy) was 4.4 in the immediate-drainage group and 2.6 in the postponed-drainage group.

· In the postponed-drainage group, 19 patients (39%) were treated conservatively with antibiotics and did not require drainage; 17 of these patients survived.

· The incidence of adverse events was similar in the two groups.

Thus, the researchers concluded that this trial did not show the superiority of immediate drainage over postponed drainage about complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions.

Reference:

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis by Boxhoorn L et. al published in the New England journal of medicine.