Association between morphological features of necrotizing pancreatitis on endoscopic ultrasound and outcomes of the endoscopic transmural step‐up approach

Abstract

Objective To investigate the association between necrotic collections on endoscopic ultrasound (EUS) and outcomes of the endoscopic transmural step‐up approach in necrotizing pancreatitis (NP). Methods Adult NP patients who had undergone endoscopic transmural step‐up approach, endoscopic transmural drainage or endoscopic transmural necrosectomy, were retrospectively enrolled, and divided into groups 1, 2 and 3 based on the amount of solid necrotic debris (quantified as a percentage of the total collection size of <30%, 30%‐50%, and >50%). Results A total of 134 patients were included, of whom 52, 59 and 23 patients were categorized into groups 1, 2 and 3. Patients with more solid necrotic debris required more necrosectomy sessions (group 3 vs group 2 vs group 1: 2.0 vs 1.0 vs 1.0, P < 0.001), were more likely to experience stent occlusion (group 3 vs group 2 vs group 1: 34.8% vs 16.9% vs 9.6%, P = 0.011), and had a longer hospitalization (group 3 vs group 2 vs group 1: 40.0 d vs 28.0 d vs 25.5 d, P = 0.015). High procalcitonin level (adjusted odds ratio [aOR] 6.14, 95% confidence interval [CI] 1.40–26.94, P = 0.016) and any organ failure (aOR 11.51, 95% CI 2.42‐54.78, P = 0.002) were independently associated with clinical failure of endoscopic transmural step‐up approach. Conclusions More solid necrotic debris on EUS is related to more necrosectomy sessions, higher incidence of stent occlusion and longer hospitalization. A nomogram combining procalcitonin and any organ failure performs well in predicting clinical failure of endoscopic transmural step‐up approach.

A location-based anatomic classification system for acute pancreatic fluid collections: Roadmap for optimal intervention in the step-up era

“…The choice of the most appropriate classification system depends on the clinical context, the availability of resources, and the purpose of the assessment. The characteristics of pancreatic fluid collections have primarily been used to predict the severity and clinic outcomes of acute pancreatitis [ 15 , 16 , [28] , [29] , [30] , [31] , [32] , [33] ]. Despite this focus on pancreatic fluid collections, anatomic location of PFCs has not been formally applied to guiding invasive procedures.…”

Endoscopic ultrasound drainage of pancreatic fluid collections: do we know enough about the best approach?

“…56 In addition, obesity and poor medical health (American Society of Anesthesiology class III) predicted necrosectomy failure with the use of PSs. 57,58 When the solid necrotic content is over 50% (Figure 1(a) and (b)), the number of DEN sessions increases to 2 or 3, 42, 59 and this represents a negative factor for predicting the success of DEN. 60 In addition, pancreatic volume necrosis >620 cm 3 was strongly associated with re-admission and reintervention in a retrospective study.…”