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The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study

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Abstract

Background and study aim

The commonly used minimally invasive methods for patients with infected pancreatic necrosis (IPN) are initial endoscopic transluminal drainage (ETD) and percutaneous catheter drainage (PCD), which are followed, if necessary, by endoscopic or surgical necrosectomy. This study intends to explore which of the two minimally invasive treatments leads to a better prognosis.

Patients and methods

Patients with IPN and an indication for intervention were prospectively enrolled and underwent either initial ETD or PCD followed, if necessary, by endoscopic or surgical necrosectomy.

Results

Initial treatment success occurred in 8 of 11 patients after ETD (72.7%) and in 3 of 13 patients after PCD (30.8%) (risk ratio [RR] with ETD, 2.36; 95% CI 0.97–5.77; P = 0.04). After 1 year of follow-up, 72.7% of patients survived with ETD, and 69.2% survived with PCD (RR 1.05; 95% CI 0.63–1.75; P = 0.85). Intestinal fistula seems to have occurred less in the patients who received initial ETD rather than PCD therapy (9.1 vs. 38.5%; RR 0.24; 95% CI 0.03–1.73; P = 0.098). Fewer patients who underwent an initial ETD were transferred to surgery (9.1 vs. 46.2%; RR 0.20; 95% CI 0.03–1.40; P = 0.047). A higher rate of new-onset diabetes (3 cases) or impaired glucose tolerance (1 case) occurred in initial PCD compared to ETD (40 vs. 0%, P = 0.042).

Conclusion

The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis (ChiCTR-ONRC-13003653).

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Acknowledgements

This research was supported by the National clinical key specialty construction project [(2011) 872], Jiangxi Provincial Science and Technology Project (20122BBG70121-1), and Science and technology project of Health and Family Planning Commission of Jiangxi province (20155112).

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    Authors and Affiliations

    1. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People’s Republic of China

      Wen-Hua He, Yong Zhu, Yin Zhu, Pi Liu, Hao Zeng, Liang Xia, Xu Shu, Zhi-Jian Liu, You-Xiang Chen & Nong-Hua Lu

    2. Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China

      Chen Yu

    3. Department of Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China

      Hai-Ming Chen

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    Drs. Wen-Hua He, Yong Zhu, Yin Zhu, Pi Liu, Hao Zeng, Liang Xia, Chen Yu, Hai-Ming Chen, Xu Shu, Zhi-Jian Liu, You-Xiang Chen, and Nong-Hua Lu have no conflicts of interest or financial ties to disclose.

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    Wen-hua He and Yong Zhu contributed equally to this manuscript.

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    He, WH., Zhu, Y., Zhu, Y. et al. The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study. Surg Endosc 31, 3004–3013 (2017). https://doi.org/10.1007/s00464-016-5324-9

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