Immediate versus postponed intervention for infected necrotizing pancreatitis
| العنوان: | Immediate versus postponed intervention for infected necrotizing pancreatitis |
|---|---|
| المؤلفون: | Boxhoorn, Lotte, van Dijk, Sven M., van Grinsven, Janneke, Verdonk, Robert C., Boermeester, Marja A., Bollen, Thomas L., Bouwense, Stefan A. W., Bruno, Marco J., Cappendijk, Vincent C., Dejong, Cornelis H. C., van Duijvendijk, Peter, van Eijck, Casper H. J., Fockens, Paul, Francken, Michiel F. G., van Goor, Harry, Hadithi, Muhammed, Hallensleben, Nora D. L., Haveman, Jan Willem, Jacobs, Maarten A. J. M., Jansen, Jeroen M., Kop, Marnix P. M., van Lienden, Krijn P., Manusama, Eric R., Mieog, Sven J. D., Molenaar, I. Quintus, Nieuwenhuijs, Vincent B., Poen, Alexander C., Poley, Jan-Werner, van de Poll, Marcel, Quispel, Rutger, Römkens, Tessa E. H., Schwartz, Matthijs P., Seerden, Tom C., Stommel, Martijn W. J., Straathof, Jan Willem A., Timmerhuis, Hester C., Venneman, Niels G., Voermans, Rogier P., van de Vrie, Wim, Witteman, Ben J., Dijkgraaf, Marcel G. W., van Santvoort, Hjalmar C., Besselink, Marc G., Study group members AMC, Stoker, Jaap |
| المساهمون: | Gastroenterology & Hepatology, Surgery, Gastroenterology and Hepatology, Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Radiology and Nuclear Medicine, Epidemiology and Data Science, APH - Methodology, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, Intensive Care, MUMC+: MA Medische Staf IC (9) |
| المصدر: | New England Journal of Medicine, 385(15), 1372-1381. Massachussetts Medical Society New England Journal of Medicine, 385(15), 1372-1381. MASSACHUSETTS MEDICAL SOC New England journal of medicine, 385(15), 1372-1381. Massachussetts Medical Society The New England Journal of Medicine, 385, 1372-1381 The New England Journal of Medicine, 385, 15, pp. 1372-1381 New England Journal of Medicine, 385(15), 1372-1381. MASSACHUSETTS MEDICAL SOCIETY |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, MEDLINE, Disease, CLASSIFICATION, law.invention, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Randomized controlled trial, law, Intervention (counseling), Catheter drainage, MANAGEMENT, Medicine, Combined Modality Therapy, STEP-UP APPROACH, OUTCOMES, business.industry, NECROSIS, General Medicine, NECROSECTOMY, medicine.disease, digestive system diseases, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Pancreatitis, business, Necrotizing pancreatitis |
| الوصف: | Item does not contain fulltext BACKGROUND: 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. METHODS: We 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 end point was the score on the Comprehensive Complication Index, which incorporates all complications over the course of 6 months of follow-up. RESULTS: 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 (mean difference, -1; 95% confidence interval [CI], -12 to 10; P = 0.90). Mortality was 13% in the immediate-drainage group and 10% in the postponed-drainage group (relative risk, 1.25; 95% CI, 0.42 to 3.68). 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 (mean difference, 1.8; 95% CI, 0.6 to 3.0). 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. CONCLUSIONS: This trial did not show the superiority of immediate drainage over postponed drainage with regard to complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions. (Funded by Fonds NutsOhra and Amsterdam UMC; POINTER ISRCTN Registry number, ISRCTN33682933.). |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 0028-4793 3368-2933 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::847ca5aac87428de2ffcce251a4ad376Test https://hdl.handle.net/11370/333aed06-0345-4c05-a54f-97be2b6444c2Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....847ca5aac87428de2ffcce251a4ad376 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00284793 33682933 |
|---|