• Charlotte L Van Veldhuisen, Noor J Sissingh, Lotte Boxhoorn, Sven M van Dijk, Janneke van Grinsven, Robert C Verdonk, Marja A Boermeester, BouwenseStefan A WSAWDepartment of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands., Marco J Bruno, Vincent C Cappendijk, Peter van Duijvendijk, van EijckCasper H JCHJDepartment of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands., Paul Fockens, Harry van Goor, Muhammed Hadithi, Jan Willem Haveman, Maarten A J M Jacobs, Jeroen M Jansen, Marnix P M Kop, Eric R Manusama, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Centre, Leiden, The Netherlands., I Quintus Molenaar, Vincent B Nieuwenhuijs, Alexander C Poen, Jan-Werner Poley, Rutger Quispel, RömkensTessa E HTEHDepartment of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands., Matthijs P Schwartz, Tom C Seerden, DijkgraafMarcel G WMGWDepartment of Epidemiology and Data Science, Amsterdam UMC, location University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands., StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Jan Willem A Straathof, Niels G Venneman, Rogier P Voermans, Jeanin E van Hooft, Hjalmar C van Santvoort, Marc G Besselink, and Dutch Pancreatitis Study Group.
• Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
• Ann. Surg. 2024 Apr 1; 279 (4): 671678671-678.

ObjectiveTo compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis.BackgroundIn the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention.MethodsClinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications.ResultsOut of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33-2.28; P =0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56-7.37; P =0.34). The median number of additional interventions was 0 (IQR 0-0) in both groups ( P =0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P =0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar.ConclusionsAlso, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach.Trial RegistrationISRCTN33682933.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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