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Risk factors for adverse outcomes at various phases of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Data from a multi-institutional consortium.
- Source :
-
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2024 May; Vol. 36 (5), pp. 600-614. Date of Electronic Publication: 2023 Oct 17. - Publication Year :
- 2024
-
Abstract
- 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.<br />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.<br />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).<br />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.<br /> (© 2023 The Authors. Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
- Subjects :
- Humans
Female
Male
Middle Aged
Risk Factors
Aged
Retrospective Studies
Ultrasonography, Interventional
Pancreatitis, Acute Necrotizing diagnostic imaging
Pancreatitis, Acute Necrotizing therapy
Pancreatitis, Acute Necrotizing surgery
Adult
Treatment Outcome
Endosonography methods
Pancreatic Pseudocyst diagnostic imaging
Pancreatic Pseudocyst surgery
Pancreatic Pseudocyst therapy
Drainage methods
Subjects
Details
- Language :
- English
- ISSN :
- 1443-1661
- Volume :
- 36
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
- Publication Type :
- Academic Journal
- Accession number :
- 37702186
- Full Text :
- https://doi.org/10.1111/den.14683