Postponed drainage beneficial with infected necrotising pancreatitis

Follow-up >6 months for necrotising pancreatitis infections with immediate or delayed drainage showed no influence on mortality or major complications.

A new POINTER follow-up study

In 2021, the POINTER trial established that postponed catheter drainage was advantageous in patients with infected necrotising pancreatitis when compared with immediate drainage, i.e. a lower necessity in interventions and a patient rate of 35% who had treatment success solely on antibiotics1. The new POINTER follow-up study strove to clarify whether or not long-term results beyond the initial 6 months would uphold these results. 

Out of 104 patients in the initial trial, 88 patients were included in the new analysis that defined a composite primary outcome of death or major complications. The baseline characteristics of the initial trial, noted no overall differences between the groups.  “The time between randomisation and drainage was 1 day in the immediate drainage group and 9 days in the postponed drainage group,” explained Ms Noor Sissingh (Leiden University Medical Centre, the Netherlands), who presented the results of the Dutch Pancreatitis Study Group trial. 

Intervention differences found regarding total follow-up evaluations

The results distinguished between new events (>6 months) and all events within the total follow-up time that extended over a median of 51 months. As for the primary outcome, the results did not show statistical difference between the 2 drainage schedules for either of the result categories. “Regarding the interventions that were performed after the initial 6 months, you can see that 7 patients in the immediate drainage group needed a drainage procedure after this period, while this were 3 patients in the postponed drainage arm. Also, it is good to mention that 1 of these was a patient that was initially treated with antibiotics only in the POINTER trial,” Ms Sissingh stressed.

Differences with regard to interventions were also found in the evaluation of the total follow-up. Compared with all patients receiving drainage per design in the immediate group, only 65% in the postponed group needed drainage, leading to a relative risk of 1.53 (P<0.0001). Moreover, a lower fraction of patients needed a necrosectomy in the postponed drainage group (51% vs 22%; P=0.004). Only in the total follow-up results, the number of interventions were significantly lower in the postponed drainage arm. 

Ms Sissingh underlined that even though there were no differences in death or major complications, hospital stay, and quality-of-life, the postponed drainage approach for infected necrotising pancreatitis continued to result in fewer interventions after the initial 6 months follow-up as compared with immediate drainage.

  1. Van Veldhuisen C, et al. Long-term outcome of the POINTER randomised trial on immediate versus postponed intervention for infected necrotizing pancreatitis. LB03, UEG Week 2022, Vienna, Austria, 8–11 October.