Pavneet Kohli1, Vikas Gupta2, Rakesh Kochhar3, Thakur D Yadav1, Saroj K Sinha3, Anupam Lal4. 1. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. 2. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address: vikaspgi@gmail.com. 3. Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. 4. Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Abstract
AIMS: There is no study comparing large volume lavage through image guided percutaneously placed drains in severe acute pancreatitis. METHODS: Of the 114 randomized patients, 60 eligible candidates were randomly allocated to - Lavage Treatment (LT) group (28 patients) and Dependent Drainage (DD) group (32 patients). Primary end point was reversal of pre-existing organ failure, development of new onset organ failure, need for surgery, mortality and hospital stay. RESULTS: Both the groups were comparable in terms of demographic data, onset and severity of pancreatitis. LT group had higher infected pancreatic necrosis (75% vs 50%,p = 0.047). On intention to treat analysis, lavage treatment group showed a significant reversal of persistent organ failure (84% vs 50%, p = 0.23), reduction in APACHEII scores (3.5 ± 3.405 vs 1.16 ± 3.811 p = 0.012), as measured at the time of placement of PCD to cessation of intervention. There was no difference in development of new onset organ failure in the two groups (25% vs37.5% p=.290). 75% in LT group and 69% in DD group improved with PCD alone. There was no difference in the catheter related complications and number of catheters used. The need for surgical intervention was comparable in two groups (18.8% vs 14.3% p=.737). There was a trend toward decreased mortality in group A (18.8% vs 28.8% p=.370). CONCLUSION: Large volume lavage trough PCD improves organ failure and this translates into trend towards reduced mortality.
RCT Entities:
AIMS: There is no study comparing large volume lavage through image guided percutaneously placed drains in severe acute pancreatitis. METHODS: Of the 114 randomized patients, 60 eligible candidates were randomly allocated to - Lavage Treatment (LT) group (28 patients) and Dependent Drainage (DD) group (32 patients). Primary end point was reversal of pre-existing organ failure, development of new onset organ failure, need for surgery, mortality and hospital stay. RESULTS: Both the groups were comparable in terms of demographic data, onset and severity of pancreatitis. LT group had higher infected pancreatic necrosis (75% vs 50%,p = 0.047). On intention to treat analysis, lavage treatment group showed a significant reversal of persistent organ failure (84% vs 50%, p = 0.23), reduction in APACHEII scores (3.5 ± 3.405 vs 1.16 ± 3.811 p = 0.012), as measured at the time of placement of PCD to cessation of intervention. There was no difference in development of new onset organ failure in the two groups (25% vs37.5% p=.290). 75% in LT group and 69% in DD group improved with PCD alone. There was no difference in the catheter related complications and number of catheters used. The need for surgical intervention was comparable in two groups (18.8% vs 14.3% p=.737). There was a trend toward decreased mortality in group A (18.8% vs 28.8% p=.370). CONCLUSION: Large volume lavage trough PCD improves organ failure and this translates into trend towards reduced mortality.