Risk factors for adverse outcomes at various phases of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Data from a multi-institutional consortium

被引：8

作者：

Saito, Tomotaka ^{[1
]}

Omoto, Shunsuke ^{[5
]}

Takenaka, Mamoru ^{[5
]}

Tsujimae, Masahiro ^{[6
]}

Masuda, Atsuhiro ^{[6
]}

Sato, Tatsuya ^{[1
]}

Hamada, Tsuyoshi ^{[1
,2
]}

Ota, Shogo ^{[7
]}

Shiomi, Hideyuki ^{[7
]}

Takahashi, Sho ^{[3
]}

Fujisawa, Toshio ^{[3
]}

Nakagawa, Keito ^{[8
]}

Matsubara, Saburo ^{[8
]}

Uemura, Shinya ^{[9
]}

Iwashita, Takuji ^{[9
]}

Yoshida, Kensaku ^{[10
]}

Maruta, Akinori ^{[10
]}

Okuno, Mitsuru ^{[11
]}

Iwata, Keisuke ^{[11
]}

Hayashi, Nobuhiko ^{[12
]}

Mukai, Tsuyoshi ^{[13
]}

Isayama, Hiroyuki ^{[3
]}

Yasuda, Ichiro ^{[12
]}

Nakai, Yousuke ^{[1
,4
,14
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[2] Japanese Fdn Canc Res, Dept Hepatobiliary Pancreat Med, Canc Inst Hosp, Tokyo, Japan

[3] Juntendo Univ, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[4] Univ Tokyo Hosp, Dept Endoscopy & Endoscop Surg, Tokyo, Japan

[5] Kindai Univ, Fac Med, Dept Gastroenterol & Hepatol, Osaka, Japan

[6] Kobe Univ, Grad Sch Med, Div Gastroenterol, Dept Internal Med, Kobe, Japan

[7] Hyogo Med Univ, Dept Internal Med, Div Gastroenterol & Hepatobiliary & Pancreat Dis, Nishinomiya, Hyogo, Japan

[8] Saitama Med Univ, Saitama Med Ctr, Dept Gastroenterol & Hepatol, Saitama, Japan

[9] Gifu Univ Hosp, Dept Internal Med 1, Gifu, Japan

[10] Gifu Prefectural Gen Med Ctr, Dept Gastroenterol, Gifu, Japan

[11] Gifu Municipal Hosp, Dept Gastroenterol, Gifu, Japan

[12] Univ Toyama, Dept Internal Med 3, Toyama, Japan

[13] Kanazawa Med Univ, Dept Gastroenterol Endoscopy, Kahokugun, Japan

[14] Univ Tokyo Hosp, Dept Endoscopy & Endoscop Surg, 7 3 1 Hongo, Bunkyo ku, Tokyo 1138655, Japan

来源：

DIGESTIVE ENDOSCOPY | 2024年 / 36卷 / 05期

关键词：

cohort study; endoscopy; endosonography; pancreatitis; stent; WALLED-OFF NECROSIS; ASIAN CONSENSUS STATEMENTS; APPOSING METAL STENTS; PREDICTING SUCCESS; CLINICAL-OUTCOMES; DRAINAGE; NECROSECTOMY; MANAGEMENT; STEP; CLASSIFICATION;

D O I：

10.1111/den.14683

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objectives: No comprehensive study has examined short- and long-term adverse outcomes of endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs) including walled-off necrosis (WON) and pseudocysts. Methods: In a multi-institutional cohort of 357 patients receiving EUS-guided treatment of PFCs (228 with WON and 129 with pseudocysts), we examined PFC type-specific risk factors for procedure-related adverse events (AEs), clinical failure, and recurrence. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the logistic and Cox regression models, respectively, adjusting for potential confounders. Results: Adverse events were observed predominantly in WON, and risk factors were WON extension to the pelvis (OR 2.49; 95% CI 1.00-6.19) and endoscopic necrosectomy (OR 5.15; 95% CI 1.61-16.5). Risk factors for clinical failure in WON treatment included higher Charlson Comorbidity Index (OR for >= 3 vs. <= 2, 2.58; 95% CI 1.05-6.35), extension to the pelvis (OR 3.63; 95% CI 1.57-8.43), nonuse of a lumen-apposing metal stent (OR 2.88; 95% CI 1.10-7.54), and percutaneous drainage (OR 3.73; 95% CI 1.27-10.9). Patients with pseudocysts extending to the paracolic gutter and the need for more than two endoscopic/percutaneous procedures had ORs for clinical failure of 5.28 (95% CI 1.10-25.3) and 5.52 (95% CI 1.61-18.9), respectively. Pseudocysts requiring the multigateway approach were associated with a high risk of recurrence (HR 4.00; 95% CI 1.11-11.6). Conclusion: The adverse outcomes at various phases of EUS-guided PFC treatment may be predictable based on clinical parameters. Further research is warranted to optimize treatment strategies for high-risk patients.

引用

页码：600 / 614

页数：15

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