Multidisciplinary management of severe acute pancreatitis

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

The aim of the studies described in this thesis is to improve the treatment of patients with severe acute pancreatitis. Patients with infected necrotizing pancreatitis are best treated with a minimally invasive step-up approach. Until recently, there was no worldwide consensus on the best timing of treatment. This thesis therefore includes the results of the multicenter randomized POINTER trial, which demonstrated that drainage directly after diagnosing infected necrosis did not lower mortality or complications. However, when the intervention was postponed, less interventions for infected necrosis were required and more than one-third of patients were successfully treated with antibiotics.
We know from previous literature (TENSION trial) that the endoscopic step-up approach has important advantages over the surgical step-up approach. Consequently, lumen-apposing metal stents (LAMS) were developed to improve endoscopic drainage. This thesis describes the results of the prospective multicenter AXIOMA study, in which the use of LAMS for endoscopic drainage was investigated. The results were compared to endoscopy group of TENSION trial, in which plastic stents were used. Our comparison showed no differences in clinical outcomes or healthcare costs. However, in contrast to previous literature, we found that LAMS did not cause more complications.
This thesis also describes the results of the ExTENSION study, in which the long-term clinical outcomes of patients who participated in the TENSION trial were investigated. The results of this study indicated that patients treated with endoscopy suffered from fewer pancreaticocutaneous fistulas and needed fewer re-interventions during long-term follow-up, in comparison to patients that were treated surgically.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam, Netherlands
Supervisors/Advisors
  • Fockens, Paul, Supervisor
  • Besselink, Marc, Supervisor
  • Voermans, Rogier, Co-supervisor
  • van Santvoort, Hjalmar C., Co-supervisor, External person
Award date25 Mar 2022
Print ISBNs9789464236736
Publication statusPublished - 2022

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