title: The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study.
abstract: The commonly used minimally invasive methods for patients with infected pancreatic necrosis (IPN) are initial endoscopic transluminal drainage (ETD) and percutaneous catheter drainage (PCD), which are followed, if necessary, by endoscopic or surgical necrosectomy. This study intends to explore which of the two minimally invasive treatments leads to a better prognosis.
  
  
  
  Patients with IPN and an indication for intervention were prospectively enrolled and underwent either initial ETD or PCD followed, if necessary, by endoscopic or surgical necrosectomy.
  
  
  
  Initial treatment success occurred in 8 of 11 patients after ETD (72.7%) and in 3 of 13 patients after PCD (30.8%) (risk ratio [RR] with ETD, 2.36; 95% CI 0.97-5.77; P = 0.04). After 1 year of follow-up, 72.7% of patients survived with ETD, and 69.2% survived with PCD (RR 1.05; 95% CI 0.63-1.75; P = 0.85). Intestinal fistula seems to have occurred less in the patients who received initial ETD rather than PCD therapy (9.1 vs. 38.5%; RR 0.24; 95% CI 0.03-1.73; P = 0.098). Fewer patients who underwent an initial ETD were transferred to surgery (9.1 vs. 46.2%; RR 0.20; 95% CI 0.03-1.40; P = 0.047). A higher rate of new-onset diabetes (3 cases) or impaired glucose tolerance (1 case) occurred in initial PCD compared to ETD (40 vs. 0%, P = 0.042).
  
  
  
  The outcomes of initial endoscopic transluminal drainage are superior to percutaneous drainage for patients with infected pancreatic necrosis (ChiCTR-ONRC-13003653).
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: He
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Pi
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Liang
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yu
authors.affiliation: Department of Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Hai-Ming
authors.initials: HM
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Xu
authors.initials: X
authors.lastname: Shu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
authors.forename: You-Xiang
authors.initials: YX
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China. lunonghua@ncu.edu.cn.
authors.forename: Nong-Hua
authors.initials: NH
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute pancreatitis; Endoscopic transluminal drainage; Infected pancreatic necrosis; Percutaneous catheter drainage