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

Vornhülz M, Sirtl S, Xu Y, Klauss S, Orgler-Gasche E, Bezmarevic M, Jovanovic M, Ricci C, Fernandez Y. Viesca M, Arvanitakis M, Hadi A, Prahm AP, Di Mauro D, Ruess DA, Focke C, Bender F, Hamm J, Ammer-Herrmenau C, Gonçalves TC, Gonçalves JC, Calavrezos L, Götz M, Stoerzer S, Schmelzle M, Nawacki Ł, Condori C, Seitzinger M, Seelig J, Chooklin S, Chuklin S, Rasch S, Phillip V, Pandanaboyana S, Aljaberi R, Kuzman M, Meinhardt C, González de la Higuera Carnicer B, Ruiz-Clavijo García D, Eross B, Hegyi P, Kerbazh N, Moga TV, Pawlak K, Calo N, Khalaf K, Brunner M, Schulte L, Kleger A, Ruiz Rebollo ML, Seidensticker M, Wildgruber M, Mansmann U, Stubbe H, Mayerle J, Beyer G (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1002/ueg2.70133

Abstract

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.

Authors with CRIS profile

Involved external institutions

Copenhagen University Hospital Denmark (DK) Ludwig-Maximilians-Universität (LMU) Germany (DE) Klinikum der Universität München (LMU Klinikum) Germany (DE) Technische Universität München (TUM) Germany (DE) Newcastle University United Kingdom (GB) Jan Kochanowski University in Kielce / Uniwersytet Jana Kochanowskiego w Kielcach Poland (PL) Bolivian-Japanese Institute of Gastroenterology (I.G.B.J.) / Instituto de Gastroenterología Boliviano Japonés (I.G.B.J.) Brazil (BR) Universitätsklinikum Leipzig Germany (DE) Lviv Regional Clinical Hospital Ukraine (UA) Hospital Clínico Universitario de Valladolid / University Clinical Hospital of Valladolid Spain (ES) Universitätsklinikum Freiburg Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) Universitätsklinikum Göttingen Germany (DE) Klinikum Oldenburg Germany (DE) Hospital Universitario de Navarra Spain (ES) Semmelweis University / Semmelweis Egyetem Hungary (HU) Poltava State Medical University (PSMU) / Полтавський державний медичний університет (ПДМУ) Ukraine (UA) Victor Babes University of Medicine and Pharmacy Romania (RO) St. Michael's Hospital Canada (CA) Universitätsklinikum Ulm Germany (DE) Alto Ave Local Health Unit / Unidade Local de Saúde do Alto Ave Portugal (PT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) University of Defence / Универзитет одбране Serbia (RS) University of Bologna / Università di Bologna Italy (IT) University of Exeter United Kingdom (GB) Hôpital Erasme Belgium (BE)

How to cite

APA:

Vornhülz, M., Sirtl, S., Xu, Y., Klauss, S., Orgler-Gasche, E., Bezmarevic, M.,... Beyer, G. (2025). Common Practice of Percutaneous Drainage in Necrotising Pancreatitis—A Multicentre Retrospective Study (DRACULA). United European Gastroenterology Journal. https://doi.org/10.1002/ueg2.70133

MLA:

Vornhülz, Marlies, et al. "Common Practice of Percutaneous Drainage in Necrotising Pancreatitis—A Multicentre Retrospective Study (DRACULA)." United European Gastroenterology Journal (2025).

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