For patients with infected necrotizing pancreatitis, an endoscopic transluminal approach compared to minimally invasive surgery significantly reduced major complications, lowered costs, and increased qualify of life. This according to a single-center, randomized trial of 66 patients with confirmed or suspected infection necrotizing pancreatitis who required intervention. Patients were randomly assigned to groups that received minimally invasive surgery (n=32) or an endoscopic step-up approach (n=34). The primary endpoint was a composite of major complications or death during 6 months of follow-up. Researchers found:
- The primary endpoint occurred in 11.8% of patients who received the endoscopic procedure and 40.6% of patients who received the minimally invasive surgery (risk ratio, 0.29).
- There was no significant difference in mortality between the groups; however, none of the patients assigned to the endoscopic approach developed enteral or pancreatic-cutaneous fistulae vs 28% of those who underwent surgery.
- The physical health scores for quality of life at 3 months was better with the endoscopic approach and mean total cost was lower.
Bang JY, Amoletti JP, Holt BA, et al. An endoscopic transluminal approach, compared to minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. [Published online ahead of print November 16, 2018]. Gastroenterology. doi:10.1053/j.gastro.2018.11.031.
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