Immediate drainage not better for infected necrotizing pancreatitis


THURSDAY, October 7, 2021 (HealthDay News) – For patients with infected necrotizing pancreatitis, immediate catheter drainage is not superior to delayed catheter drainage in reducing complications, according to a study published in the issue of October 7 from the New England Journal of Medicine.

Lotte Boxhoorn, MD, University of Amsterdam, and colleagues conducted a randomized superiority trial involving patients with infected necrotizing pancreatitis who were randomly assigned to receive immediate drainage within 24 hours of randomization ( 55 patients) or drainage that was postponed until it was walled up. necrosis was achieved (49 patients).

The researchers found that the mean score on the complete complication index was 57 and 58 in the immediate and delayed drainage groups, respectively (mean difference, -1; 95% confidence interval [CI], -12 to 10; p = 0.90). Mortality was 13 and 10 percent in the immediate and delayed drainage groups, respectively (relative risk, 1.25; 95 percent CI, 0.42 to 3.68). The mean number of procedures (catheter drainage and necrosectomy) was 4.4 and 2.6 in the immediate and delayed drainage groups, respectively (mean difference 1.8; 95% CI 0.6 to 3 , 0). Nineteen patients (39%) in the delayed drainage group were treated conservatively with antibiotics and did not require drainage; 17 survived.

“This trial did not show the hypothetical benefit of early catheter drainage in patients with infected necrotizing pancreatitis,” the authors write. “These results suggest that an initial conservative approach with antibiotics is warranted when infected necrosis is diagnosed.” Several authors have disclosed financial ties to pharmaceutical companies.

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