TY - JOUR
T1 - Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial)
T2 - study protocol for a randomized controlled trial
AU - van Grinsven, Janneke
AU - van Dijk, Sven M.
AU - Dijkgraaf, Marcel G.
AU - Boermeester, Marja A.
AU - Bollen, Thomas L.
AU - Bruno, Marco J.
AU - van Brunschot, Sandra
AU - Dejong, Cornelis H.
AU - van Eijck, Casper H.
AU - van Lienden, Krijn P.
AU - Boerma, Djamila
AU - van Duijvendijk, Peter
AU - Hadithi, Muhammed
AU - Haveman, Jan Willem
AU - van der Hulst, Rene W.
AU - Jansen, Jeroen M.
AU - Lips, Daan J.
AU - Manusama, Eric R.
AU - Molenaar, I. Quintus
AU - van der Peet, Donald L.
AU - Poen, Alexander C.
AU - Quispel, Rutger
AU - Schaapherder, Alexander F.
AU - Schoon, Erik J.
AU - Schwartz, Matthijs P.
AU - Seerden, Tom C.
AU - Spanier, B. W. Marcel
AU - Straathof, Jan Willem
AU - Venneman, Niels G.
AU - van de Vrie, Wim
AU - Witteman, Ben J.
AU - van Goor, Harry
AU - Fockens, Paul
AU - van Santvoort, Hjalmar C.
AU - Besselink, Marc G.
AU - Dutch Pancreatitis Study Grp
PY - 2019/4/25
Y1 - 2019/4/25
N2 - 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.
AB - 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.
KW - Necrotizing pancreatitis
KW - Infection
KW - Step-up approach
KW - Timing
KW - Drainage
KW - Complication
KW - Randomized controlled trial
KW - STEP-UP APPROACH
KW - PERCUTANEOUS CATHETER DRAINAGE
KW - CLOSED PACKING
KW - NECROSECTOMY
KW - CLASSIFICATION
KW - INTERVENTION
KW - DEBRIDEMENT
KW - EXPERIENCE
KW - MANAGEMENT
KW - STERILE
U2 - 10.1186/s13063-019-3315-6
DO - 10.1186/s13063-019-3315-6
M3 - Article
C2 - 31023380
VL - 20
JO - Trials
JF - Trials
SN - 1745-6215
M1 - 239
ER -