Inverse association of hospital volume with in-hospital mortality rate of patients receiving EUS-guided interventions for pancreatic fluid collections

Hamada, Takashi; Michihata, Nobuaki; Saito, Tomotaka; Iwashita, Takuji; Shiomi, Hideyuki; Takenaka, Mamoru; Matsui, Hiroki; Fushimi, Kiyohide; Isayama, Hiroyuki; Yasuda, Ichiro; Yasunaga, Hideo; Nakai, Yousuke

doi:10.1016/j.gie.2023.04.2091

Cited by 7 publications

(2 citation statements)

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“…[2][3][4][5] With the increasing popularity of endoscopic ultrasound (EUS)-guided transmural interventions in this setting, PFCs requiring treatment are commonly managed via nonsurgical procedures. [6][7][8][9][10][11][12] The emerging treatment modality of lumen-apposing metal stents (LAMS) has accelerated the trend toward the nonsurgical treatment through serving as a transmural port for safe and effective endoscopic necrosectomy (EN) following EUS-guided drainage of WON. 4,7,13 Despite the reported effectiveness of EUS-guided treatment of PFCs, attention should be paid to adverse outcomes at various treatment phases, 14 including procedure-related adverse events (AEs), treatment failure, and PFC recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…When symptomatic PFCs become unamenable to conservative management, the patients are referred to interventional programs 2–5 . With the increasing popularity of endoscopic ultrasound (EUS)‐guided transmural interventions in this setting, PFCs requiring treatment are commonly managed via nonsurgical procedures 6–12 . The emerging treatment modality of lumen‐apposing metal stents (LAMS) has accelerated the trend toward the nonsurgical treatment through serving as a transmural port for safe and effective endoscopic necrosectomy (EN) following EUS‐guided drainage of WON 4,7,13 …”

Section: Introductionmentioning

confidence: 99%

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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,

Omoto,

Takenaka

et al. 2023

Digestive Endoscopy

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ObjectivesNo 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.MethodsIn 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.ResultsAEs 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), non‐use 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 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 high risk of recurrence (HR, 4.00; 95% CI, 1.11‐11.6).ConclusionsThe 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 (registration number, UMIN000044130).

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