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Tytuł:
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Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents.
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Autorzy:
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Chandrasekhara V; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: .
Elhanafi S; Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas.
Storm AC; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Takahashi N; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Lee NJ; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Levy MJ; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Kaura K; Department of Internal Medicine, East Carolina University, Greenville, North Carolina.
Wang L; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Majumder S; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Vege SS; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Law RJ; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Abu Dayyeh BK; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Źródło:
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Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2021 Oct; Vol. 19 (10), pp. 2192-2198. Date of Electronic Publication: 2021 Jun 02.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003-
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MeSH Terms:
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Drainage*
Endosonography*
Humans ; Retrospective Studies ; Stents ; Treatment Outcome
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Contributed Indexing:
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Keywords: Acute Pancreatitis; EUS; Lumen-Apposing Metal Stents; Pseudocyst; Walled-Off Necrosis
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Entry Date(s):
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Date Created: 20210509 Date Completed: 20211004 Latest Revision: 20220606
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Update Code:
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20240105
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DOI:
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10.1016/j.cgh.2021.05.005
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PMID:
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33965573
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Background & Aims: A significant proportion of individuals with pancreatic fluid collections (PFCs) require step-up therapy after endoscopic drainage with lumen-apposing metal stents. The aim of this study is to identify factors associated with PFCs that require step-up therapy.
Methods: A retrospective cohort study of patients undergoing endoscopic ultrasound-guided drainage of PFCs with lumen-apposing metal stents from April 2014 to October 2019 at a single center was performed. Step-up therapy included direct endoscopic necrosectomy, additional drainage site (endoscopic or percutaneous), or surgical intervention after the initial drainage procedure. Multivariable logistic regression was performed using a backward stepwise approach with a P ≤ .2 threshold for variable retention to identify factors predictive for the need for step-up therapy.
Results: One hundred thirty-six patients were included in the final study cohort, of whom 69 (50.7%) required step-up therapy. Independent predictors of step-up therapy included: collection size measuring ≥10 cm (odds ratio [OR], 8.91; 95% confidence interval [CI], 3.36-23.61), paracolic extension of the PFC (OR, 4.04; 95% CI, 1.60-10.23), and ≥30% solid necrosis (OR, 4.24; 95% CI, 1.48-12.16). In a sensitivity analysis of 81 patients with walled-off necrosis, 51 (63.0%) required step-up therapy. Similarly, factors predictive of the need for step-up therapy for walled-off necrosis included: collection size measuring ≥10 cm (OR, 6.94; 95% CI, 1.76-27.45), paracolic extension of the PFC (OR, 3.79; 95% CI, 1.18-12.14), and ≥30% solid necrosis (OR, 7.10; 95% CI, 1.16-43.48).
Conclusions: Half of all patients with PFCs drained with lumen-apposing metal stents required step-up therapy, most commonly direct endoscopic necrosectomy. Individuals with PFCs ≥10 cm in size, paracolic extension, or ≥30% solid necrosis are more likely to require step-up therapy and should be considered for early endoscopic reintervention.
(Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Comment in: Clin Gastroenterol Hepatol. 2022 May;20(5):e1219-e1220. (PMID: 34000378)
Comment in: Clin Gastroenterol Hepatol. 2022 Jun;20(6):e1507-e1508. (PMID: 34224875)
