Necrosectomy and its timing in relation to clinical outcomes of endoscopic ultrasound-guided treatment of walled-off pancreatic necrosis: a multicenter study.

Autor: Tsujimae M; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan., Saito T; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Sakai A; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan., Takenaka M; Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan., Omoto S; Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan., Hamada T; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan., Ota S; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan., Shiomi H; Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan., Takahashi S; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan., Fujisawa T; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan., Suda K; Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan., Matsubara S; Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan., Uemura S; First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan., Iwashita T; First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan., Yoshida K; Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan., Maruta A; Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan., Okuno M; Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan., Iwata K; Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan., Hayashi N; Third Department of Internal Medicine, University of Toyama, Toyama, Japan., Mukai T; Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan., Yasuda I; Third Department of Internal Medicine, University of Toyama, Toyama, Japan., Isayama H; Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan., Nakai Y; Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: ynakai-tky@umin.ac.jp., Masuda A; Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan. Electronic address: atmasuda@med.kobe-u.ac.jp.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2024 Nov 25. Date of Electronic Publication: 2024 Nov 25.
DOI: 10.1016/j.gie.2024.11.039
Abstrakt: Background and Aims: Endoscopic ultrasound (EUS)-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly utilized to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared to the drainage-based approach.
Methods: Within a multi-institutional cohort of 423 patients with pancreatic fluid collections including 227 patients with WON, we identified 153 patients who received the step-up treatment following the initial EUS-guided drainage of symptomatic WON, including 102 EN patients and 51 non-EN (drainage) patients. Using the competing-risks multivariable proportional hazards regression model with adjustment for potential confounders, we calculated subdistribution hazard ratios (SHRs) for clinical treatment success (WON resolution) by the use of EN and its timing.
Results: Compared to drainage alone, the EN-based treatment was associated with a shorter time to clinical success with a multivariable SHR of 1.66 (95% confidence interval, 1.12-2.46). Despite a higher risk of procedure-related bleeding in the EN group, there were no differences in the rates of severe adverse events (7.8% vs. 5.9% in the EN and non-EN groups, respectively) and mortality (6.9% vs. 9.8%). In the EN-treated patients, the timing of EN was not statistically significantly associated with the time to clinical success (P trend = 0.34) CONCLUSION: Among patients receiving EUS-guided treatment of symptomatic WON, the use of EN in addition to drainage procedures was associated with earlier disease resolution. Further research is desired to determine the optimal timing of initiating EN considering a risk-benefit balance and cost-effectiveness.
(Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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