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Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

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Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. / van Brunschot, Sandra; Hollemans, Robbert A; Bakker, Olaf J; Besselink, Marc G; Baron, Todd H; Beger, Hans G; Boermeester, Marja A; Bollen, Thomas L; Bruno, Marco J; Carter, Ross; French, Jeremy J; Coelho, Djalma; Dahl, Björn; Dijkgraaf, Marcel G; Doctor, Nilesh; Fagenholz, Peter J; Farkas, Gyula; Castillo, Carlos Fernandez Del; Fockens, Paul; Freeman, Martin L; Gardner, Timothy B; Goor, Harry van; Gooszen, Hein G; Hannink, Gerjon; Lochan, Rajiv; McKay, Colin J; Neoptolemos, John P; Oláh, Atilla; Parks, Rowan W; Peev, Miroslav P; Raraty, Michael; Rau, Bettina; Rösch, Thomas; Rovers, Maroeska; Seifert, Hans; Siriwardena, Ajith K; Horvath, Karen D; van Santvoort, Hjalmar C.

In: GUT, Vol. 67, No. 4, 04.2018, p. 697-706.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

van Brunschot, S, Hollemans, RA, Bakker, OJ, Besselink, MG, Baron, TH, Beger, HG, Boermeester, MA, Bollen, TL, Bruno, MJ, Carter, R, French, JJ, Coelho, D, Dahl, B, Dijkgraaf, MG, Doctor, N, Fagenholz, PJ, Farkas, G, Castillo, CFD, Fockens, P, Freeman, ML, Gardner, TB, Goor, HV, Gooszen, HG, Hannink, G, Lochan, R, McKay, CJ, Neoptolemos, JP, Oláh, A, Parks, RW, Peev, MP, Raraty, M, Rau, B, Rösch, T, Rovers, M, Seifert, H, Siriwardena, AK, Horvath, KD & van Santvoort, HC 2018, 'Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients', GUT, vol. 67, no. 4, pp. 697-706. https://doi.org/10.1136/gutjnl-2016-313341

APA

van Brunschot, S., Hollemans, R. A., Bakker, O. J., Besselink, M. G., Baron, T. H., Beger, H. G., Boermeester, M. A., Bollen, T. L., Bruno, M. J., Carter, R., French, J. J., Coelho, D., Dahl, B., Dijkgraaf, M. G., Doctor, N., Fagenholz, P. J., Farkas, G., Castillo, C. F. D., Fockens, P., ... van Santvoort, H. C. (2018). Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. GUT, 67(4), 697-706. https://doi.org/10.1136/gutjnl-2016-313341

Vancouver

van Brunschot S, Hollemans RA, Bakker OJ, Besselink MG, Baron TH, Beger HG et al. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. GUT. 2018 Apr;67(4):697-706. https://doi.org/10.1136/gutjnl-2016-313341

Bibtex

@article{3bf7d20f898e4916948617120ab16d47,
title = "Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients",
abstract = "OBJECTIVE: Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking.DESIGN: We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%).RESULTS: Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005).CONCLUSION: In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.",
keywords = "Journal Article",
author = "{van Brunschot}, Sandra and Hollemans, {Robbert A} and Bakker, {Olaf J} and Besselink, {Marc G} and Baron, {Todd H} and Beger, {Hans G} and Boermeester, {Marja A} and Bollen, {Thomas L} and Bruno, {Marco J} and Ross Carter and French, {Jeremy J} and Djalma Coelho and Bj{\"o}rn Dahl and Dijkgraaf, {Marcel G} and Nilesh Doctor and Fagenholz, {Peter J} and Gyula Farkas and Castillo, {Carlos Fernandez Del} and Paul Fockens and Freeman, {Martin L} and Gardner, {Timothy B} and Goor, {Harry van} and Gooszen, {Hein G} and Gerjon Hannink and Rajiv Lochan and McKay, {Colin J} and Neoptolemos, {John P} and Atilla Ol{\'a}h and Parks, {Rowan W} and Peev, {Miroslav P} and Michael Raraty and Bettina Rau and Thomas R{\"o}sch and Maroeska Rovers and Hans Seifert and Siriwardena, {Ajith K} and Horvath, {Karen D} and {van Santvoort}, {Hjalmar C}",
note = "{\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.",
year = "2018",
month = apr,
doi = "10.1136/gutjnl-2016-313341",
language = "English",
volume = "67",
pages = "697--706",
journal = "GUT",
issn = "0017-5749",
publisher = "BMJ PUBLISHING GROUP",
number = "4",

}

RIS

TY - JOUR

T1 - Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

AU - van Brunschot, Sandra

AU - Hollemans, Robbert A

AU - Bakker, Olaf J

AU - Besselink, Marc G

AU - Baron, Todd H

AU - Beger, Hans G

AU - Boermeester, Marja A

AU - Bollen, Thomas L

AU - Bruno, Marco J

AU - Carter, Ross

AU - French, Jeremy J

AU - Coelho, Djalma

AU - Dahl, Björn

AU - Dijkgraaf, Marcel G

AU - Doctor, Nilesh

AU - Fagenholz, Peter J

AU - Farkas, Gyula

AU - Castillo, Carlos Fernandez Del

AU - Fockens, Paul

AU - Freeman, Martin L

AU - Gardner, Timothy B

AU - Goor, Harry van

AU - Gooszen, Hein G

AU - Hannink, Gerjon

AU - Lochan, Rajiv

AU - McKay, Colin J

AU - Neoptolemos, John P

AU - Oláh, Atilla

AU - Parks, Rowan W

AU - Peev, Miroslav P

AU - Raraty, Michael

AU - Rau, Bettina

AU - Rösch, Thomas

AU - Rovers, Maroeska

AU - Seifert, Hans

AU - Siriwardena, Ajith K

AU - Horvath, Karen D

AU - van Santvoort, Hjalmar C

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/4

Y1 - 2018/4

N2 - OBJECTIVE: Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking.DESIGN: We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%).RESULTS: Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005).CONCLUSION: In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.

AB - OBJECTIVE: Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking.DESIGN: We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%).RESULTS: Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005).CONCLUSION: In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.

KW - Journal Article

U2 - 10.1136/gutjnl-2016-313341

DO - 10.1136/gutjnl-2016-313341

M3 - SCORING: Journal article

C2 - 28774886

VL - 67

SP - 697

EP - 706

JO - GUT

JF - GUT

SN - 0017-5749

IS - 4

ER -