A small-scale randomised trial unveiled a promising treatment option for people with confirmed or suspected infected necrotising pancreatitis.
Results showcased the potential benefits of upfront endoscopic necrosectomy over a step-up approach, especially for stable patients with extensive necrosis.
The trial, conducted by Dr Shyam Varadarajulu and his team from the Orlando Health Digestive Health Institute in Florida, involved 70 patients undergoing drainage with endoscopic transluminal stenting.
The findings indicated that immediately following stenting, performing an upfront necrosectomy significantly reduced subsequent interventions required for successful treatment compared to reserving this procedure for more challenging cases.
The upfront approach led to fewer reinterventions (median one versus two over a six-month period) and demonstrated higher success rates in a shorter timeframe.
This translated to expedited clinical recovery, reduced length of hospital stays and potentially lowered healthcare costs.
Acute pancreatitis annually contributes to more than 275,000 hospitalisations in the US with a fifth of these cases progressing to necrosis, a condition associated with elevated mortality rates, especially if it involves organ failure and infected necrotic tissue.
The conventional step-up method, previously adopted to address this condition, involves antibiotics, drainage and necrosectomy for non-responders.
Yet, it demands numerous reinterventions and extended hospital stays, leading to uncertainty regarding the best treatment approach.
Dr Varadarajulu’s team cautioned that upfront necrosectomy might not suit all patients, emphasising its potential harm in certain cases or in unstable patients during the early phases of the illness.
The study, known as the DESTIN study, screened 183 adults across multiple hospitals in the US and India.
Of these, 37 underwent upfront necrosectomy, while 33 followed the step-up treatment approach. Notably, eligibility criteria required a necrosis extent of 33% or more.
Results showcased that it triggered faster clinical improvement, earlier discharge and potentially lower treatment costs than the step-up approach.
However, overall treatment success rates and mortality did not significantly differ between the two methods.
The study is published in The Lancet Gastroenterology & Hepatology.
The authors write: ‘Although we found no significant difference in treatment success and adverse events, such an approach could expedite clinical recovery, minimise the need for reinterventions, and shorten the length of hospital stay and, thereby, reduce healthcare costs.’
This trial marks a significant step in refining treatment strategies for infected necrotising pancreatitis, offering a potential alternative that warrants further exploration and careful consideration in patient-specific scenarios.
