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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2020

01-03-2020 | Ultrasound

Multivariate analysis of the factors affecting the prognosis of walled-off pancreatic necrosis after endoscopic ultrasound-guided drainage

Authors: Jintao Guo, Bowen Duan, Siyu Sun, Sheng Wang, Xiang Liu, Nan Ge, Wen Liu, Shupeng Wang, Jinlong Hu

Published in: Surgical Endoscopy | Issue 3/2020

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Abstract

Background and aims

Endoscopic ultrasound (EUS)-guided drainage has become the treatment of choice for walled-off pancreatic necrosis (WOPN). However, no consensus exists on the most significant patient- and procedure-related factors that affect prognosis. The aim of the study is to investigate the correlation between patient- and procedure-related factors and post-procedure complications after EUS-guided drainage.

Methods

A retrospective analysis of the clinical characteristics of patients with WOPN who underwent EUS-guided drainage at our endoscopy center between November 2011 and August 2017 was performed. Chi-square analysis and binary logistic regression statistical methods were used to analyze the correlation between influencing factors and prognosis.

Results

A total of 85 patients (male/female, 50/35) with WOPN were included in the study. The average age was 44.95 years. The cyst diameter was 10.58 ± 4.78 cm. Multivariate analysis showed that WOPN with higher solid content (> 30%) increased the probability of endoscopic necrosectomy (OR 6.798; 95% CI 1.423, 32.470; p = 0.016). The use of a metal stent increased the probability of endoscopic necrosectomy (OR 3.503; 95% CI 1.251, 9.810; p = 0.017) and the length of hospitalization (OR 3.315; 95% CI 1.192, 9.215; p = 0.022). Female patients had a higher probability of requiring endoscopic necrosectomy (OR 2.683; 95% CI 1.027, 7.007; p = 0.044) and prolonged hospitalization (OR 2.675; 95% CI 1.065, 6.721; p = 0.036).

Conclusion

The solid content of WOPN, type of stent, and sex of patients were associated with increased probability of endoscopic necrosectomy.
Literature
1.
Braha J, Tenner S (2018) Fluid collections and pseudocysts as a complication of acute pancreatitis. Gastrointest Endosc Clin N Am 28(2):123–130PubMedCrossRef
2.
ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, Acosta RD, Bruining DH, Chathadi KV, Eloubeidi MA, Faulx AL, Fonkalsrud L, Gurudu SR, Khashab MA, Kothari S, Lightdale JR, Pasha SF, Saltzman JR, Shaukat A, Wang A, Yang J, Cash BD, DeWitt JM (2016) The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 83(3):481–488CrossRef
3.
Varadarajulu S, Bang JY, Phadnis MA, Christein JD, Wilcox CM (2011) Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg 15(11):2080–2088PubMedCrossRef
4.
Singhal S, Rotman SR, Gaidhane M, Kahaleh M (2013) Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc 46(5):506–514PubMedPubMedCentralCrossRef
5.
Adler DG (2018) Single-operator experience with a 20-mm diameter lumen apposing metal stent to treat patients with large pancreatic fluid collections from pancreatic necrosis. Endosc Ultrasound 7:422–423PubMedPubMedCentralCrossRef
6.
Steinberg WM (2010) A step-up approach, or open necrosectomy for necrotizing pancreatitis. N Engl J Med 363(13):1286–1287PubMedCrossRef
7.
Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, van Eijck CH, Fockens P, Hazebroek EJ, Nijmeijer RM, Poley JW, van Ramshorst B, Vleggaar FP, Boermeester MA, Gooszen HG, Weusten BL, Timmer R, Dutch Pancreatitis Study Group (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 307(10):1053–1061PubMedCrossRef
8.
Khan MA, Hammad T, Khan Z, Lee W, Gaidhane M, Tyberg A, Kahaleh M (2018) Endoscopic versus percutaneous management for symptomatic pancreatic fluid collections: a systematic review and meta-analysis. Endosc Int Open 6(4):E474–E483PubMedPubMedCentralCrossRef
9.
10.
11.
12.
Watanabe Y, Mikata R, Yasui S, Ohyama H, Sugiyama H, Sakai Y, Tsuyuguchi T, Kato N (2017) Short- and long-term results of endoscopic ultrasound-guided transmural drainage for pancreatic pseudocysts and walled-off necrosis. World J Gastroenterol 23(39):7110–7118PubMedPubMedCentralCrossRef
13.
Rana SS, Bhasin DK, Sharma RK, Kathiresan J, Gupta R (2014) Do the morphological features of walled off pancreatic necrosis on endoscopic ultrasound determine the outcome of endoscopic transmural drainage? Endosc Ultrasound 3(2):118–122PubMedPubMedCentralCrossRef
14.
Reddy MS, Udgiri N (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 127(4):1277 author reply 1277-8 PubMedCrossRef
15.
Morgan DE, Baron TH, Smith JK, Robbin ML, Kenney PJ (1997) Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 203(3):773–778PubMedCrossRef
16.
Itoi T, Nageshwar Reddy D, Yasuda I (2013) New fully-covered self-expandable metal stent for endoscopic ultrasonography-guided intervention in infectious walled-off pancreatic necrosis (with video). J Hepatobiliary Pancreat Sci 20(3):403–406PubMedCrossRef
17.
Mukai S, Itoi T, Baron TH, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Ishii K, Tsuji S, Ikeuchi N, Tanaka R, Umeda J, Tonozuka R, Honjo M, Gotoda T, Moriyasu F, Yasuda I (2015) Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series. Endoscopy 47(1):47–55PubMed
18.
Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J, Siddiqui UD, Waxman I, Joshi V, Benias PC, Darwin P, DiMaio CJ, Mulder CJ, Friedland S, Forcione DG, Sejpal DV, Gonda TA, Gress FG, Gaidhane M, Koons A, DeFilippis EM, Salgado S, Weaver KR, Poneros JM, Sethi A, Ho S, Kumbhari V, Singh VK, Tieu AH, Parra V, Likhitsup A, Womeldorph C, Casey B, Jonnalagadda SS, Desai AP, Carr-Locke DL, Kahaleh M, Siddiqui AA (2016) Endoscopic therapy with lumen-apposing metal stents is safe and effective for patients with pancreatic walled-off necrosis. Clin Gastroenterol Hepatol 14(12):1797–1803PubMedCrossRef
19.
Li L, Cristofaro S, Qu C et al (2018) EUS-guided drainage of pancreatic fluid collection with a Hot AXIOS stent in a patient with pancreatitis following distal pancreatectomy (with video). Endosc Ultrasound 7:347–348PubMedPubMedCentralCrossRef
20.
Adler DG, Shah J, Nieto J, Binmoeller K, Bhat Y, Taylor LJ, Siddiqui AA (2018) Placement of lumen-apposing metal stents to drain pseudocysts and walled-off pancreatic necrosis can be safely performed on an outpatient basis: a multicenter study. Endosc Ultrasound 8(1):36–42PubMedCentral
21.
Chen YI, Barkun AN, Adam V, Bai G, Singh VK, Bukhari M, Gutierrez OB, Elmunzer BJ, Moran R, Fayad L, El Zein M, Kumbhari V, Repici A, Khashab MA (2018) Cost-effectiveness analysis comparing lumen-apposing metal stents with plastic stents in the management of pancreatic walled-off necrosis. Gastrointest Endosc 88(2):267–276PubMedCrossRef
22.
Lang GD, Fritz C, Bhat T, Das KK, Murad FM, Early DS, Edmundowicz SA, Kushnir VM, Mullady DK (2018) EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates. Gastrointest Endosc 87(1):150–157PubMedCrossRef
23.
Hammad T, Khan MA, Alastal Y, Lee W, Nawras A, Ismail MK, Kahaleh M (2018) Efficacy and safety of lumen-apposing metal stents in management of pancreatic fluid collections: are they better than plastic stents? A systematic review and meta-analysis. Dig Dis Sci 63(2):289–301PubMedCrossRef
24.
Bang JY, Hasan M, Navaneethan U, Hawes R, Varadarajulu S (2017) Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 66(12):2054–2056PubMedCrossRef
25.
Vazquez-Sequeiros E, Baron TH, Pérez-Miranda M, Sánchez-Yagüe A, Gornals J, Gonzalez-Huix F, de la Serna C, Gonzalez Martin JA, Gimeno-Garcia AZ, Marra-Lopez C, Castellot A, Alberca F, Fernandez-Urien I, Aparicio JR, Legaz ML, Sendino O, Loras C, Subtil JC, Nerin J, Perez-Carreras M, Diaz-Tasende J, Perez G, Repiso A, Vilella A, Dolz C, Alvarez A, Rodriguez S, Esteban JM, Juzgado D, Albillos A, Spanish Group for FCSEMS in Pancreas Collections (2016) Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry. Gastrointest Endosc 84(3):450–457PubMedCrossRef
26.
Rinninella E, Kunda R, Dollhopf M, Sanchez-Yague A, Will U, Tarantino I, Gornals Soler J, Ullrich S, Meining A, Esteban JM, Enz T, Vanbiervliet G, Vleggaar F, Attili F, Larghi A (2015) EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc 82(6):1039–1046PubMedCrossRef
27.
Venkatachalapathy SV, Bekkali N, Pereira S, Johnson G, Oppong K, Nayar M, Leeds J, Paranandi B, Penman I, Carroll N, Godfrey E, James M, Aithal G, McKay C, Devlin J, Wong T, Makin A, Ryan B, Huggett M (2018) Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections. Endosc Int Open 6(3):E259–E265PubMedPubMedCentralCrossRef
28.
Bang JY, Hasan MK, Navaneethan U, Sutton B, Frandah W, Siddique S, Hawes RH, Varadarajulu S (2017) Lumen-apposing metal stents for drainage of pancreatic fluid collections: when and for whom? Dig Endosc 29(1):83–90PubMedCrossRef
29.
Caillol F, Godat S, Turrini O et al (2019) Fluid collection after partial pancreatectomy: EUS drainage and long-term follow-up. Endosc Ultrasound 8(2):91–98PubMedCrossRef
30.
Poornachandra KS, Bhasin DK, Nagi B, Sinha SK, Rana SS, Shafiq N, Greer K, Gupta R, Kang M, Malhotra S, Singh K (2011) Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis. J Clin Gastroenterol 45(2):159–163PubMedCrossRef
31.
van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, Boermeester MA, van Goor H, Dejong CH, van Eijck CH, van Ramshorst B, Schaapherder AF, van der Harst E, Hofker S, Nieuwenhuijs VB, Brink MA, Kruyt PM, Manusama ER, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, Cuesta MA, Wahab PJ, Gooszen HG, Dutch Pancreatitis Study Group (2011) A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141(4):1254–1263PubMedCrossRef
32.
Gardner TB, Coelho-Prabhu N, Gordon SR, Gelrud A, Maple JT, Papachristou GI, Freeman ML, Topazian MD, Attam R, Mackenzie TA, Baron TH (2011) Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 73(4):718–726PubMedCrossRef
Metadata
Title
Multivariate analysis of the factors affecting the prognosis of walled-off pancreatic necrosis after endoscopic ultrasound-guided drainage
Authors
Jintao Guo
Bowen Duan
Siyu Sun
Sheng Wang
Xiang Liu
Nan Ge
Wen Liu
Shupeng Wang
Jinlong Hu
Publication date
01-03-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06870-3

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