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. 2024 Feb 12;409(1):58.
doi: 10.1007/s00423-024-03244-9.

Endoscopic and surgical treatment of necrotizing pancreatitis-a comparison of short- and long-term outcome

Lea Timmermann  1 , Svenja Schönauer  2 , Karl Herbert Hillebrandt  2 , Matthäus Felsenstein  2 , Johann Pratschke  2 , Thomas Malinka #  2 , Christian Jürgensen #  3
Affiliations

Endoscopic and surgical treatment of necrotizing pancreatitis-a comparison of short- and long-term outcome

Lea Timmermann et al. Langenbecks Arch Surg. .

Abstract

Background: Acute necrotizing pancreatitis is still related to high morbidity and mortality rates. Minimal-invasive treatment options, such as endoscopic necrosectomy, may decrease peri-interventional morbidity and mortality. This study aims to compare the initial operative with endoscopic treatment on long-term parameters, such as endocrine and exocrine functionality, as well as mortality and recurrence rates.

Methods: We included 114 patients, of whom 69 were treated with initial endoscopy and 45 by initial surgery. Both groups were further assessed for peri-interventional and long-term parameters.

Results: In the post-interventional phase, patients in the group of initial surgical treatment (IST) showed significantly higher rates of renal insufficiency (p < 0.001) and dependency on invasive ventilation (p < 0.001). The in-house mortality was higher in the surgical group, with 22% vs. 10.1% in the group of patients following initial endoscopic treatment (IET; p = 0.077). In long-term follow-up, the overall mortality was 45% for IST and 31.3% for IET (p = 0.156). The overall in-hospital stay and intensive care unit (ICU) stay were significantly shorter after IET (p < 0.001). In long-term follow-up, the prevalence of endocrine insufficiency was 50% after IST and 61.7% after IET (p = 0.281). 57.1% of the patients following IST and 16.4% of the patients following IET had persistent exocrine insufficiency at that point (p = < 0.001). 8.9% of the IET and 27.6% of the IST patients showed recurrence of acute pancreatitis (p = 0.023) in the long-term phase.

Conclusion: In our cohort, an endoscopic step-up approach led to a reduced in-hospital stay and peri-interventional morbidity. The endocrine function appeared comparable in both groups, whereas the exocrine insufficiency seemed to recover in the endoscopic group in the long-term phase. These findings advocate for a preference for endoscopic treatment of acute necrotizing pancreatitis whenever feasible.

Keywords: Endoscopic necrosectomy; Necrotizing pancreatitis; Peri-interventional morbidity and mortality.

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Conflict of interest statement

Dr. med. Lea Timmermann, Svenja Schönauer, Dr. med. Karl Herbert Hillebrandt, Dr. med. Matthäus Felsenstein and Dr. med. Christian Jürgensen have no con-flicts of interest or financial ties to disclose. Prof. Dr. Johann Pratschke reports personal fees or non-financial support from Johnson &; Johnson, DP Medsystems, Medtronic GmbH, Navigant, Falk Foundation, CHG Meridian, Noggo, Astellas, Promedicis, La Fourse Group, Merck Serono GmbH, Neovii, Chiesi, Med Tech, pharma-consult Peterson, I + E-research, Exafield GmbH, Euro-transplant, Intuitive, Biba Group, DSO, DTG, ESOT, ÖCK, UEG, ESOT and Fraunhofer Institut. Prof. Dr. Thomas Malinka reports on other support from Intuitive Surgical Deutschland GmbH.

Figures

Fig. 1
Fig. 1
Overall survival function comparing patients undergoing either initial surgery or endoscopy
See this image and copyright information in PMC

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