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Multicenter Study
. 2024 May;36(5):600-614.
doi: 10.1111/den.14683. Epub 2023 Oct 17.

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

Tomotaka Saito  1 , Shunsuke Omoto  2 , Mamoru Takenaka  2 , Masahiro Tsujimae  3 , Atsuhiro Masuda  3 , Tatsuya Sato  1 , Tsuyoshi Hamada  1   4 , Shogo Ota  5 , Hideyuki Shiomi  5 , Sho Takahashi  6 , Toshio Fujisawa  6 , Keito Nakagawa  7 , Saburo Matsubara  7 , Shinya Uemura  8 , Takuji Iwashita  8 , Kensaku Yoshida  9 , Akinori Maruta  9 , Mitsuru Okuno  10 , Keisuke Iwata  10 , Nobuhiko Hayashi  11 , Tsuyoshi Mukai  12 , Hiroyuki Isayama  6 , Ichiro Yasuda  11 , Yousuke Nakai  1   13 ; WONDERFUL study group in Japan
Collaborators, Affiliations
Multicenter Study

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

Tomotaka Saito et al. Dig Endosc. 2024 May.

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.

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.

Keywords: cohort study; endoscopy; endosonography; pancreatitis; stent.

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Conflict of interest statement

Author H.I. has received research funding from Boston Scientific Japan, Fujifilm, and Piolax Medical Devices, honoraria from Boston Scientific Japan, Century Medical, Create Medic, Fujifilm, Gadelius Medical, Hitachi Medical, Japan Lifeline, Kaneka, Kawasumi Laboratories, Olympus Medical, Piolax Medical Devices, Sumitomo Bakelite, UMIDAS, and Zeon Medical, and contributions from Boston Scientific Japan, Gadelius Medical, Japan Lifeline, and Zeon Medical. Y.N. is an Associate Editor of Digestive Endoscopy and has received research funding from Boston Scientific Japan, Century Medical, Fujifilm, Gadelius Medical, HOYA Pentax Medical, Hitachi Medical, Kaneka, and Medico's Hirata, and honoraria from Boston Scientific Japan, Fujifilm, Gadelius Medical, Hitachi Medical, J‐MIT, Medico's Hirata, and Olympus Medical. M.Takenaka and T.I. are Associate Editors of Digestive Endoscopy. This work was not supported by any of those companies. The other authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
Study outline. (a) Adverse outcomes at various phases of endoscopic ultrasound (EUS)‐guided interventions for pancreatic fluid collections (PFCs). (b) Flow diagram of selection of patients undergoing EUS‐guided interventions for pancreatic fluid collections. AE, adverse event; IPMA, intraductal papillary mucinous adenoma; PDAC, pancreatic ductal adenocarcinoma; WON, walled‐off necrosis.
Figure 2
Figure 2
Kaplan–Meier curves of times to (a) clinical success and (b) recurrence following clinical success among patients undergoing endoscopic ultrasound (EUS)‐guided interventions for pancreatic fluid collections (PFCs). P‐values are shown for the log‐rank test comparing walled‐off necrosis (WON) and pseudocysts.
Figure 3
Figure 3
A large walled‐off necrosis (WON) with clinical success achieved after multiple endoscopic sessions. (a) Contrast‐enhanced computed tomography (CT) demonstrated a large WON extending both to the head and tail of pancreas. (b) Second lumen‐apposing metal stent (LAMS) was deployed as the multigateway approach. (c) Endoscopic necrosectomy was performed through each LAMS. (d) After several sessions of endoscopic necrosectomy, necrotic tissue was completely removed. (e) Contrast‐enhanced CT confirmed clinical success.
See this image and copyright information in PMC

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