Long-Term Outcome of Immediate Versus Postponed" Intervention in Patients With Infected Necrotizing Pancreatitis" (POINTER)" Multicenter Randomized Trial

Charlotte L. Van Veldhuisen, Noor J. Sissingh, Lotte Boxhoorn, GROUP investigators, Sven M. van Dijk, Janneke van Grinsven, Robert C. Verdonk, Marja A. Boermeester, Stefan A.W. Bouwense, Marco J. Bruno, Vincent C. Cappendijk, Peter van Duijvendijk, Casper H.J. van Eijck, Paul Fockens, Harry van Goor, Muhammed Hadithi, Jan Willem Haveman, Maarten A.J.M. Jacobs, Jeroen M. Jansen, Marnix P.M. KopEric R. Manusama, J. D.Sven Mieog, I. Quintus Molenaar, Vincent B. Nieuwenhuijs, Alexander C. Poen, Jan Werner Poley, Rutger Quispel, Tessa E.H. Romkens, Matthijs P. Schwartz, Tom C. Seerden, Marcel G.W. Dijkgraaf, Martijn W.J. Stommel, Jan Willem A. Straathof, Niels G. Venneman, Rogier P. Voermans, Jeanin E. van Hooft, Hjalmar C. van Santvoort, Marc G. Besselink*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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 followup 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.

Original languageEnglish
Pages (from-to)671-678
Number of pages8
JournalAnnals of Surgery
Volume279
Issue number4
DOIs
Publication statusPublished - 1 Apr 2024

Bibliographical note

Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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