Journal Article

Common Practice of Percutaneous Drainage in Necrotising Pancreatitis—A Multicentre Retrospective Study (DRACULA)

Focke, Carola, Aljaberi, Rami, Khalaf, Kareem, Seitzinger, Max, Seidensticker, Max, Hegyi, Peter, Arvanitakis, Marianna, Ruiz‐Clavijo García, David, Vornhülz, Marlies, Schmelzle, Moritz, Moga, Tudor Voicu, Meinhardt, Christian, Orgler‐Gasche, Elisabeth, Prahm, August Pilegaard, Klauss, Sarah, Stubbe, Hans, Chuklin, Serhii, Kerbazh, Nizar, Di Mauro, Davide, Sirtl, Simon, Hamm, Jacob, Gonçalves, João Carlos, Xu, Yujun, Götz, Mara, Gonçalves, Tiago Cúrdia, González de la Higuera Carnicer, Belén, Nawacki, Łukasz, Hadi, Amer, Calo, Natalia, Brunner, Maximilian, Stoerzer, Simon, Calavrezos, Lenika, Ammer‐Herrmenau, Christoph, Rasch, Sebastian, Mansmann, Ulrich, Ruiz Rebollo, María Lourdes, Kuzman, Matta, Ruess, Dietrich A., Mayerle, Julia, Pawlak, Katarzyna, Fernandez Y. Viesca, Michael, Condori, Carlos, Bezmarevic, Mihailo, Beyer, Georg, Ricci, Claudio, Kleger, Alexander, Jovanovic, Milan, Chooklin, Serge, Pandanaboyana, Sanjay, Schulte, Lucas, Wildgruber, Moritz, Seelig, Julian, Eross, Bálint, Phillip, Veit, Bender, Fabienne

2025

Overview

Background and Aims Acute necrotising pancreatitis carries high mortality, especially if infected necrosis occurs. While percutaneous drainage may be required when internal drainage is not feasible, reliable guidelines for managing percutaneous drains are lacking. This study aimed to assess the common practice of percutaneous drainage therapy for infected pancreatic necrosis. Methods This retrospective study among 29 tertiary care centres included all patients hospitalised for necrotising acute pancreatitis from 01/2016 until 12/2022 with at least one percutaneous drain. The length of hospital stay was the primary endpoint, with mortality as the secondary endpoint. Between‐group comparisons were conducted using the ratio of restricted mean survival time (RMST) after adjusting for confounders. Results 585 patients (67% male) from 29 tertiary care centres in 15 countries in Europe, Canada and Bolivia were included in the analysis. Length of hospitalisation or mortality did not differ between the flushed (n = 398) and non‐flushed groups (RMST ratio 1.04, p‐value = 0.42 and RMST ratio 1.05, p‐value = 0.1 respectively). Mortality was significantly lower in those patients who received a combination of percutaneous and internal drains (dual‐modality drainage, n = 243) as compared to those who received percutaneous drains only (RMST ratio 1.05, p‐value = 0.01). Flushing with antibiotics as compared to saline was not associated with shorter length of hospital stay or lower mortality (RMST ratio 0.98, p‐value = 0.78 and 0.97, p‐value = 0.48 respectively). Conclusions This study reveals notable differences in therapeutic concepts and flushing management for percutaneous drains. While flushing itself was not associated with a shorter length of hospitalisation or lower in‐hospital mortality, a lower mortality was observed when internal and percutaneous drainage were used in combination. Clinical Trial Registration The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) under the registration number DRKS00032231. Key Summary Summarise the established knowledge on this subject ◦ Percutaneous drainage as well as endoscopic drainage can be used for the treatment of necrotic collections in pancreatitis ◦ Management of percutaneous drains, including flushing and combination with endoscopic drains, is unclear What are the significant and/or new findings of this study? ◦ Very heterogeneous therapeutic regimens across participating pancreas centres ◦ No differences in hospitalisation or mortality for flushing versus no flushing ◦ No differences in hospitalisation or mortality for flushing with antibiotics versus saline ◦ Lower mortality in patients with dual‐modality drainage

• Subject: Adult / Aged / drainage / Drainage - adverse effects / Drainage - methods / Drainage - statistics & numerical data / Europe - epidemiology / Female / flushing / Humans / Length of Stay - statistics & numerical data / Male / Middle Aged / necrosis / pancreatitis / Pancreatitis, Acute Necrotizing - mortality / Pancreatitis, Acute Necrotizing - surgery / Pancreatitis, Acute Necrotizing - therapy / Retrospective Studies / Tertiary Care Centers - statistics & numerical data / Treatment Outcome