Long-term outcome of immediate versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): multicenter randomized trial

Veldhuisen, C.L. van; Sissingh, N.J.; Boxhoorn, L.; Dijk, S.M. van; Grinsven, J. van; Verdonk, R.C.; Boermeester, M.A.; Bouwense, S.A.W.; Bruno, M.J.; Cappendijk, V.C.; Duijvendijk, P. van; Eijck, C.H.J. van; Fockens, P.; Goor, H. van; Hadithi, M.; Haveman, J.W.; Jacobs, M.A.J.M.; Jansen, J.M.; Kop, M.P.M.; Manusama, E.R.; Mieog, J.S.D.; Molenaar, I.Q.; Nieuwenhuijs, V.B.; Poen, A.C.; Poley, J.W.; Quispel, R.; Römkens, T.E.H.; Schwartz, M.P.; Seerden, T.C.; Dijkgraaf, M.G.W.; Stommel, M.W.J.; Straathof, J.W.A.; Venneman, N.G.; Voermans, R.P.; Hooft, J.E. van; Santvoort, H.C. van; Besselink, M.G.; Dutch Pancreatitis Study Grp

doi:doi:10.1097/SLA.0000000000006001

Objective:

To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis.

Background:

In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention.

Methods:

Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications.

Results:

Out of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33–2.28; P=0.78). Additional drainage procedures were...

Objective:

To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis.

Background:

In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention.

Methods:

Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications.

Results:

Out of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33–2.28; P=0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56–7.37; P=0.34). The median number of additional interventions was 0 (IQR 0–0) in both groups (P=0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P=0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar.

Conclusions:

Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach.

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Long-term outcome of immediate versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER) multicenter randomized trial