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Endoscopic Approaches in Necrotizing Pancreatitis

Gastroenterology; ePub 2018 Nov 16; Bang, et al

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.

Citation:

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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