Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial): study protocol for a randomized controlled trial

Janneke van Grinsven*, Sven M. van Dijk, Marcel G. Dijkgraaf, Marja A. Boermeester, Thomas L. Bollen, Marco J. Bruno, Sandra van Brunschot, Cornelis H. Dejong, Casper H. van Eijck, Krijn P. van Lienden, Djamila Boerma, Peter van Duijvendijk, Muhammed Hadithi, Jan Willem Haveman, Rene W. van der Hulst, Jeroen M. Jansen, Daan J. Lips, Eric R. Manusama, I. Quintus Molenaar, Donald L. van der PeetAlexander C. Poen, Rutger Quispel, Alexander F. Schaapherder, Erik J. Schoon, Matthijs P. Schwartz, Tom C. Seerden, B. W. Marcel Spanier, Jan Willem Straathof, Niels G. Venneman, Wim van de Vrie, Ben J. Witteman, Harry van Goor, Paul Fockens, Hjalmar C. van Santvoort, Marc G. Besselink*, Dutch Pancreatitis Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

BackgroundInfected necrosis complicates 10% of all acute pancreatitis episodes and is associated with 15-20% mortality. The current standard treatment for infected necrotizing pancreatitis is the step-up approach (catheter drainage, followed, if necessary, by minimally invasive necrosectomy). Catheter drainage is preferably postponed until the stage of walled-off necrosis, which usually takes 4weeks. This delay stems from the time when open necrosectomy was the standard. It is unclear whether such delay is needed for catheter drainage or whether earlier intervention could actually be beneficial in the current step-up approach. The POINTER trial investigates if immediate catheter drainage in patients with infected necrotizing pancreatitis is superior to the current practice of postponed intervention.MethodsPOINTER is a randomized controlled multicenter superiority trial. All patients with necrotizing pancreatitis are screened for eligibility. In total, 104 adult patients with (suspected) infected necrotizing pancreatitis will be randomized to immediate (within 24h) catheter drainage or current standard care involving postponed catheter drainage. Necrosectomy, if necessary, is preferably postponed until the stage of walled-off necrosis, in both treatment arms. The primary outcome is the Comprehensive Complication Index (CCI), which covers all complications between randomization and 6-month follow up. Secondary outcomes include mortality, complications, number of (repeat) interventions, hospital and intensive care unit (ICU) lengths of stay, quality-adjusted life years (QALYs) and direct and indirect costs. Standard follow-up is at 3 and 6months after randomization.DiscussionThe POINTER trial investigates if immediate catheter drainage in infected necrotizing pancreatitis reduces the composite endpoint of complications, as compared with the current standard treatment strategy involving delay of intervention until the stage of walled-off necrosis.Trial registrationISRCTN, 33682933. Registered on 6 August 2015. Retrospectively registered.

Original languageEnglish
Article number239
Number of pages10
JournalTrials
Volume20
DOIs
Publication statusPublished - 25 Apr 2019

Keywords

  • Necrotizing pancreatitis
  • Infection
  • Step-up approach
  • Timing
  • Drainage
  • Complication
  • Randomized controlled trial
  • STEP-UP APPROACH
  • PERCUTANEOUS CATHETER DRAINAGE
  • CLOSED PACKING
  • NECROSECTOMY
  • CLASSIFICATION
  • INTERVENTION
  • DEBRIDEMENT
  • EXPERIENCE
  • MANAGEMENT
  • STERILE

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