Comment on “Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER)”: Multicenter Randomized Trial

作者：Shuirong Lin, Ziming Song, Xi Yu, Wenxuan Xie, Shunli Shen, Ming Kuang · 发表于：Annals of Surgery Open · 年份：2024 · DOI：10.1097/as9.0000000000000503 · 研究领域：Pancreatitis Pathology and Treatment、Pancreatic and Hepatic Oncology Research、Gastrointestinal disorders and treatments

We read with great interest the article recently published in the Annals of Surgery entitled “Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): Multicenter Randomized Trial,”1 and published in The New England Journal of Medicine entitled “Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis.”2 The authors pointed out that postponed drainage with antibiotics in patients with infected necrotizing pancreatitis reduces interventions compared to immediate drainage and offers the opportunity to effectively treat patients with antibiotic therapy alone without increasing the risk of long-term adverse outcomes. However, we have the following concerns about this study. First, in this study, it was pointed out that catheter drainage was performed on an average of 24 days after the onset of acute pancreatitis symptoms in the immediate drainage group, while catheter drainage was performed on an average of 34 days after the onset of symptoms in the postponed drainage group. At the same time, it was observed that 33 patients (60%) in the immediate drainage group and 21 patients (70%) in the postponed drainage group had largely or fully encapsulated pancreatic and peripancreatic necrosis before drainage. However, the size and distribution of encapsulated effusion have not been detailed in this article, and whether these will affect the timing of drainage interventions. Second, in the early obser...