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

TLDR: In patients with infected necrotising pancreatitis, the endoscopic step-up approach was not superior to the surgical step- up approach in reducing major complications or death, and the rate of pancreatic fistulas and length of hospital stay were lower in the endoscopy group.

About: This article is published in The Lancet.The article was published on 2018-01-06 and is currently open access. It has received 442 citations till now. The article focuses on the topics: Standard treatment & Clinical endpoint.

Figures

Table 1: Baseline characteristics

Table 2: Primary and secondary endpoints according to the intention-to-treat analysis

Frequently asked questions

Q1. What are the contributions mentioned in the paper "Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial" ?

Sandra van Brunschot, Janneke van Grinsven, Hjalmar C van Santvoort, Olaf J Bakker, Marc G Besselink, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Stefan A Bouwense, Marco J Bruno, Vincent C Cappendijk, Esther C Consten, Cornelis H Dejong, Casper H van Eijck, Willemien G Erkelens, Harry van Goor, Wilhelmina M U van Grevenstein, Jan-Willem Haveman, Sijbrand H Hofker, Jeroen M Jansen, Johan S Laméris, Krijn P van Lienden, Maarten A Meijssen, Chris J Mulder, Vincent B Nieuwenhuijs, Jan-Werner Poley, Rutger Quispel, Rogier J de Ridder, Tessa E Römkens, Joris J Scheepers, Nicolien J Schepers, Matthijs P Schwartz, Tom Seerden, B W Marcel Spanier, Jan Willem A Straathof, Marin Strijker, Robin Timmer, Niels G Venneman, Frank P Vleggaar, Rogier P Voermans, Ben J Witteman, Hein G Gooszen, Marcel G Dijkgraaf, Paul Fockens, for the Dutch Pancreatitis Study Group * 

Q2. What contributions have the authors mentioned in the paper "Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial" ?

Sandra van Brunschot, Janneke van Grinsven, Hjalmar C van Santvoort, Olaf J Bakker, Marc G Besselink, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Stefan A Bouwense, Marco J Bruno, Vincent C Cappendijk, Esther C Consten, Cornelis H Dejong, Casper H van Eijck, Willemien G Erkelens, Harry van Goor, Wilhelmina M U van Grevenstein, Jan-Willem Haveman, Sijbrand H Hofker, Jeroen M Jansen, Johan S Laméris, Krijn P van Lienden, Maarten A Meijssen, Chris J Mulder, Vincent B Nieuwenhuijs, Jan-Werner Poley, Rutger Quispel, Rogier J de Ridder, Tessa E Römkens, Joris J Scheepers, Nicolien J Schepers, Matthijs P Schwartz, Tom Seerden, B W Marcel Spanier, Jan Willem A Straathof, Marin Strijker, Robin Timmer, Niels G Venneman, Frank P Vleggaar, Rogier P Voermans, Ben J Witteman, Hein G Gooszen, Marcel G Dijkgraaf, Paul Fockens, for the Dutch Pancreatitis Study Group * 

Q3. What was the primary endpoint of the study?

The endoscopic approach consisted of endoscopic ultrasound-guided transluminal drainage followed, if necessary, by endoscopic necrosectomy. 

Q4. How many patients were enrolled in the endoscopic or surgical approach?

The primary endpoint occurred in 22 (43%) of 51 patients in the endoscopy group and in 21 (45%) of 47 patients in the surgery group (risk ratio [RR] 0·97, 95% CI 0·62–1·51; p=0·88). 

Q5. How many patients were enrolled in this trial?

In this multicentre, randomised, superiority trial, the authors recruited adult patients with infected necrotising pancreatitis and an indication for invasive intervention from 19 hospitals in the Netherlands.