Proinflammatory response to treatment of infected necrotizing pancreatitis may be reduced through the use of endoscopic transgastric necrosectomy as opposed to surgical necrosectomy, according to recent results.
The randomized, controlled assessor-masked trial was conducted at three academic hospitals and one teaching hospital in the Netherlands from August 20, 2008 to March 3, 2010. Participants included 22 patients with infected necrotizing pancreatitis randomized into two groups receiving either endoscopic transgastric necrosectomy (n=10) or surgical necrosectomy (n=12), with follow-up at 3 and 6 months after discharge. Evaluated factors included the proinflammatory response after the procedure and the presence of major complications, including organ failure, intra-abdominal bleeding, fistulas and death. Investigators measured proinflammatory responses in participants using serum interleukin 6 (IL-6) levels.
In the surgical necrosectomy group, two participants were excluded because they did not require necrosectomy after percutaneous catheter drainage. Among the remaining patients, the proinflammatory response was lower in the endoscopic group than in the surgical group (P=.004), and the composite clinical endpoint of major complications occurred less frequently in the endoscopic group (20% compared with 80%; RD=0.60; 95% CI, 0.16-0.80). Specific complications also were fewer in the endoscopic group, including multiple organ failure, which occurred in 0% of endoscopic patients and 50% of surgical patients (RD=0.50; 95% CI, 0.12-0.76) and pancreatic fistulas, which occurred in 10% of endoscopic and 70% of surgical patients (RD=0.60; 95% CI, 0.17-0.81).
“In this first randomized clinical trial … endoscopic transgastric necrosectomy reduced the proinflammatory response as well as the composite clinical endpoint … compared with surgical necrosectomy,” the researchers wrote. “However, these early, promising results require confirmation from a larger clinical trial.”