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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.
Saito, Tomotaka; Omoto, Shunsuke; Takenaka, Mamoru; Tsujimae, Masahiro; Masuda, Atsuhiro; Sato, Tatsuya; Hamada, Tsuyoshi; Ota, Shogo; Shiomi, Hideyuki; Takahashi, Sho; Fujisawa, Toshio; Nakagawa, Keito; Matsubara, Saburo; Uemura, Shinya; Iwashita, Takuji; Yoshida, Kensaku; Maruta, Akinori; Okuno, Mitsuru; Iwata, Keisuke; Hayashi, Nobuhiko; Mukai, Tsuyoshi; Isayama, Hiroyuki; Yasuda, Ichiro; Nakai, Yousuke.
Afiliación
  • Saito T; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Omoto S; Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.
  • Takenaka M; Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.
  • Tsujimae M; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
  • Masuda A; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
  • Sato T; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Hamada T; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Ota S; Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
  • Shiomi H; Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
  • Takahashi S; Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan.
  • Fujisawa T; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
  • Nakagawa K; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
  • Matsubara S; Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
  • Uemura S; Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
  • Iwashita T; First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
  • Yoshida K; First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
  • Maruta A; Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
  • Okuno M; Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
  • Iwata K; Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
  • Hayashi N; Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
  • Mukai T; Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
  • Isayama H; Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan.
  • Yasuda I; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
  • Nakai Y; Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
Dig Endosc ; 2023 Sep 13.
Article en En | MEDLINE | ID: mdl-37702186
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Dig Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Australia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Dig Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Australia