TY - JOUR
T1 - Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial)
T2 - design and rationale of a randomised controlled multicenter trial
AU - van Brunschot, Sandra
AU - van Grinsven, Janneke
AU - Voermans, Rogier P.
AU - Bakker, Olaf J.
AU - Besselink, Marc G. H.
AU - Boermeester, Marja A.
AU - Bollen, Thomas L.
AU - Bosscha, Koop
AU - Bouwense, Stefan A.
AU - Bruno, Marco J.
AU - Cappendijk, Vincent C.
AU - Consten, Esther C.
AU - Dejong, Cornelis H.
AU - Dijkgraaf, Marcel G. W.
AU - van Eijck, Casper H.
AU - Erkelens, G. Willemien
AU - van Goor, Harry
AU - Hadithi, Mohammed
AU - Haveman, Jan-Willem
AU - Hofker, Hendrik
AU - Jansen, Jeroen J. M.
AU - Lameris, Johan S.
AU - van Lienden, Krijn P.
AU - Manusama, Eric R.
AU - Meijssen, Maarten A.
AU - Mulder, Chris J.
AU - Nieuwenhuis, Vincent B.
AU - Poley, Jan-Werner
AU - de Ridder, Rogier J.
AU - Rosman, Camiel
AU - Schaapherder, Alexander F.
AU - Scheepers, Joris J.
AU - Schoon, Erik J.
AU - Seerden, Tom
AU - Spanier, B. W. Marcel
AU - Straathof, Jan Willem A.
AU - Timmer, Robin
AU - Venneman, Niels G.
AU - Vleggaar, Frank P.
AU - Witteman, Ben J.
AU - Gooszen, Hein G.
AU - van Santvoort, Hjalmar C.
AU - Fockens, Paul
AU - Dutch Pancreatitis Study Grp
PY - 2013/11/25
Y1 - 2013/11/25
N2 - Background: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if necessary, by (minimally invasive) surgical necrosectomy has become the standard of care. A promising minimally invasive alternative is the endoscopic transluminal step-up approach. This approach consists of endoscopic transluminal drainage followed, if necessary, by endoscopic transluminal necrosectomy. We hypothesise that the less invasive endoscopic step-up approach is superior to the surgical step-up approach in terms of clinical and economic outcomes.Methods/Design: The TENSION trial is a randomised controlled, parallel-group superiority multicenter trial. Patients with (suspected) infected necrotising pancreatitis with an indication for intervention and in whom both treatment modalities are deemed possible, will be randomised to either an endoscopic transluminal or a surgical step-up approach. During a 4 year study period, 98 patients will be enrolled from 24 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite of death and major complications within 6 months following randomisation. Secondary endpoints include complications such as pancreaticocutaneous fistula, exocrine or endocrine pancreatic insufficiency, need for additional radiological, endoscopic or surgical intervention, the need for necrosectomy after drainage, the number of (re-)interventions, quality of life, and total direct and indirect costs.Discussion: The TENSION trial will answer the question whether an endoscopic step-up approach reduces the combined primary endpoint of death and major complications, as well as hospital stay and related costs compared with a surgical step-up approach in patients with infected necrotising pancreatitis.
AB - Background: Infected necrotising pancreatitis is a potentially lethal disease that nearly always requires intervention. Traditionally, primary open necrosectomy has been the treatment of choice. In recent years, the surgical step-up approach, consisting of percutaneous catheter drainage followed, if necessary, by (minimally invasive) surgical necrosectomy has become the standard of care. A promising minimally invasive alternative is the endoscopic transluminal step-up approach. This approach consists of endoscopic transluminal drainage followed, if necessary, by endoscopic transluminal necrosectomy. We hypothesise that the less invasive endoscopic step-up approach is superior to the surgical step-up approach in terms of clinical and economic outcomes.Methods/Design: The TENSION trial is a randomised controlled, parallel-group superiority multicenter trial. Patients with (suspected) infected necrotising pancreatitis with an indication for intervention and in whom both treatment modalities are deemed possible, will be randomised to either an endoscopic transluminal or a surgical step-up approach. During a 4 year study period, 98 patients will be enrolled from 24 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite of death and major complications within 6 months following randomisation. Secondary endpoints include complications such as pancreaticocutaneous fistula, exocrine or endocrine pancreatic insufficiency, need for additional radiological, endoscopic or surgical intervention, the need for necrosectomy after drainage, the number of (re-)interventions, quality of life, and total direct and indirect costs.Discussion: The TENSION trial will answer the question whether an endoscopic step-up approach reduces the combined primary endpoint of death and major complications, as well as hospital stay and related costs compared with a surgical step-up approach in patients with infected necrotising pancreatitis.
KW - Acute pancreatitis
KW - Necrotising
KW - Treatment
KW - Drainage
KW - Trial
KW - Endoscopy
KW - Minimally invasive
KW - Surgery
KW - Necrosectomy
KW - Pancreas
KW - HEALTH-CARE
KW - NECROSECTOMY
KW - NECROSIS
KW - DEBRIDEMENT
KW - GUIDELINES
KW - MANAGEMENT
KW - THERAPY
KW - ABSCESS
KW - VIDEOS
U2 - 10.1186/1471-230X-13-161
DO - 10.1186/1471-230X-13-161
M3 - Article
SN - 1471-230X
VL - 13
JO - Bmc gastroenterology
JF - Bmc gastroenterology
M1 - 161
ER -