Endoscopische versus chirurgische behandeling van geïnfecteerde necrotiserende pancreatitis: de TENSION-studie

In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. An alternative treatment is an endoscopic step-up approach consisting of endoscopic transluminal drainage, if necessary followed by endoscopic transluminal necrosectomy. The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).

Conflict of interest: Fockens received royalties from Elsevier Publishers. The institute of Fockens received reimbursements for advice from Boston Scientific, Cook and Torax Medical. Research grants were received by the institutes of Gooszen (NutsOhra Fund), of Van Brunschot (NutsOhra Fund and the Dutch Stomach-Liver-Intestine Foundation) and of Van Santvoort (Dutch Stomach-Liver-Intestine Foundation). Financial support for this article: none declared.