Role of Early Percutaneous Drainage of Symptomatic Acute Fluid Collections in Moderately Severe and Severe Acute Pancreatitis: A Randomised Study

Objective: The step-up approach for severe acute pancreatitis (SAP) has gained considerable traction. However, there is no consensus on percutaneous drainage (PCD) of early (<4 weeks) acute fluid collections (AFCs), some of which may produce mass effects and worsening inflammation. We designed a prospective randomised study to determine the role of PCD in symptomatic AFCs in SAP. Materials and Methods: Our prospective randomised study divided patients of moderately SAP (MSAP) and SAP with symptomatic (mass effect, fever, anorexia, and poor organ scores) AFCs into two groups:– Group 1 for conservative management (CM) and Group 2 for PCD. Requisite ethics and scientific clearances were obtained. The primary outcome variable was hospital stay; some other recorded variables included mortality, organ scores, sequential organ failure assessment (SOFA), and intra-abdominal pressure (IAP). Results: Of 78 patients with acute pancreatitis in 18 months, 38 (49%) fulfilled the inclusion criteria. Group 1 or CM had 20, and Group 2 or PCD had 18 patients; 16 from each group were eventually compared. No significant differences were observed in any clinical or outcome parameter except better day 7 SOFA scores and IAP in Group 2 (SOFA: 1.69 ± 1.55 vs. 3.33 ± 1.35, P = 0.013; IAP in mm Hg: 9.29 ± 1.82 vs. 13.81 ± 2.71, P < 0.001). Overall, four patients (10.5%) underwent necrosectomy, while mortality and hospital stay did not differ significantly between the groups. Conclusion: PCD in appropriately selected patients of MSAP and SAP with AFCs can hasten recovery, slow down organ damage, and decrease IAP significantly. More studies with a larger sample are needed in this area.