Early on‐demand drainage or standard management for acute pancreatitis patients with acute necrotic collections and persistent organ failure: a pilot randomized controlled trial

Background/Purpose

The current standard care for acute pancreatitis with acute necrotic collections (ANC) is to postpone invasive intervention for four weeks when indicated. However, in patients with persistent organ failure (POF), this delayed approach may prolong organ failure. In this study, we aimed to assess the feasibility and safety of earlier drainage for acute pancreatitis patients with ANC and POF.

Methods

A single‐center, randomized controlled trial was conducted. Eligible patients were randomly assigned to either the early on‐demand (EOD) group or the standard management(SM) group. Within 21 days of randomization, early drainage was triggered by unremitted or worsening organ failure in the EOD group. The primary endpoint was a composite of major complications/death during 90‐days follow‐up.

Results

30 patients were randomized. Within 21 days of randomization, 8/15 patients (53%) in the EOD group underwent percutaneous drainage, while 4/15 patients (27%) in the SM group did so (P=0.26). The primary outcome occurred in 3/15 (20%) patients in the EOD group and 7/15(46.7%) in the controls (p=0.25, relative risk 0.43, 95%CI 0.14 to1.35).