Immediate vs. postponed drainage yields similar results for necrotizing pancreatitis
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Immediate catheter drainage was not superior to postponed drainage in patients with infected necrotizing pancreatitis, according to results presented at UEG Week.
"The POINTER trial did not show the superiority of immediate catheter drainage when compared with postponed catheter drainage,” Lotte Boxhoorn, MD, PhD, from the department of gastroenterology and hepatology at Amsterdam University Medical Center, said. “With the postponed drainage approach, less interventions may be needed, and more than one-third of patients may be treated without any interventions with antibiotics only.”
In a randomized trial, Boxhoorn and colleagues assigned 104 patients from 22 Dutch hospitals with necrotizing pancreatitis to immediate catheter drainage (n = 55) or postponed catheter drainage (n = 49). Immediate catheter drainage occurred median 22 days after acute pancreatitis onset while postponed catheter drainage occurred after a median 29 days. The Comprehensive Complication Index, covering complications during the 6-months follow-up, served as the primary end point. Other endpoints included mortality, major complications, total number of interventions and total length of intensive care and hospital stay during 6 months of follow-up.
At randomization, the investigators performed a subgroup analysis in patients with organ failure.
“We did not find a difference in Comprehensive Complication Index when we compared the immediate drainage group to the postponed drainage group,” Boxhoorn said. “The number of complications weighted for severity was equal.”
Results showed no differences between groups regarding mortality (11% vs. 10%; RR = 1.07; 95% CI, 0.35-3.29), new-onset organ failure (25% vs. 22%; RR = 1.13; 95% CI, 0.57-2.26) or other major complications. Investigator noted length of intensive care was equal in the immediate and postponed drainage groups (mean 12 days for both). Further, total hospital stay was not significantly different during the 6-month follow-up (mean 59 vs. 51 days; P = .07).
According to researchers, the median number of interventions was significantly higher in the immediate drainage group compared with the postponed drainage group (median 4 vs. 1 intervention; P < .001). Nineteen patients in the postponed drainage group received antibiotics alone, without drainage, or necrosectomy during 6 months of follow-up.
Boxhoorn and colleagues did not observe a difference in the primary endpoint among patients with organ failure at randomization (median CCI, 79.77 vs. 90.57; P = 0.51).
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Boxhoorn L, et al. OP007. Presented at: UEG Week; Oct. 11-13, 2020.
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