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The Lancet Publishes Findings of Necrotizing Pancreatitis Research Study from Multicenter Collaboration

November 20, 2023
Pancreatitis Research Study 1 web
CT scan revealing acute necrotic collection in lesser sac.

Ground-breaking research led by Orlando Health Digestive Health Institute has been published in The Lancet Gastroenterology & Hepatology. The manuscript, entitled Upfront endoscopic necrosectomy or step-up endoscopic approach for infected necrotising pancreatitis (DESTIN): a single-blinded, multicentre, randomised trial, resulted from the institute’s multicenter collaboration with the University of Southern California, the University of West Virginia, Rush University and the Asian Institute of Gastroenterology in India.

Shyam Varadarajulu, MD
Shyam Varadarajulu, MD

The study, which ran from November 2019 to October 2022, analyzed the benefits of endoscopic interventions to determine the optimal treatment strategy in patients with infected necrotizing pancreatitis. The single-blind randomized trial included 70 patients and compared the outcomes between performing upfront necrosectomy at index intervention versus step-up approach.

“While transluminal stenting followed by performance of endoscopic necrosectomy as step-up treatment in patients without clinical improvement has been the traditional management approach, the optimal timing for performance of necrosectomy was unclear,” says Shyam S. Varadarajulu, MD, president of Orlando Health Digestive Health Institute. “This is the first study to make a comparison and reach definitive conclusions.”

Pancreatitis Research Study 3 web
Intubation of necrotic cavity for endoscopic debridement.

The clinical trial provided high-level evidence to substantiate the treatment approach that in stabilized patients with infected necrotizing pancreatitis and well demarcated collections, performing endoscopic necrosectomy at index treatment session resulted in numerous benefits. These included an early resolution of systemic inflammation and organ failure, less reinterventions, shorter lengths of hospital stay and lower costs as compared to step-up approach.

Pancreatitis Research Study 2 web
Endoscopic view of trans-gastric drainage.

“We concluded that necrosectomy performed the first day the stent is placed decreases the number of interventions with no increase to risk,” says Dr. Varadarajulu. “We believe the outcome of this trial will likely result in a shift to upfront necrosectomy as the treatment preference.”

As one of the nation’s most highly regarded digestive disease programs, Orlando Health Digestive Health Institute offers comprehensive and coordinated care to evaluate, diagnose and treat a wide range of digestive diseases. The institute’s internationally respected specialists lead numerous studies testing innovative interventions for complex digestive diseases and are frequent contributors to leading publications on gastroenterology and endoscopy globally.

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