Risk factors for bleeding in patients with acute necrotizing pancreatitis undergoing endoscopic necrosectomy

Analysis of factors influencing the complications of severe acute pancreatitis combined with hemorrhage

“…In recent years, with the popularization of minimally invasive step-up strategy, the bleeding complications related to necrotic drainage and endoscopic debridement have increased, making more attention paid to such complications [22,23]. Our retrospective study analyzed the correlation between endoscopic debridement and bleeding risk, and further explored the relationship between the number and time of debridement with bleeding, previous studies considered multiple necrotic drainage and endoscopic debridement may increase bleeding risk [16,24], but in our study, although the number of endoscopic debridements was higher in the bleeding group than in the non-bleeding group (20.4%VS15%), however, the number of endoscopic debridements did not affect bleeding risk (P = 0.477), similarly, there was no signi cant difference in the intervention time of endoscopic debridement between two groups (P = 0.233), we believed that the intervention time of debridement is not an independent risk factor, that is, the timing of debridement intervention does not affect bleeding risk, this conclusion is also consistent with a recent high-quality multicenter study [25]. About endoscopic necrosectomy, although the proportion of endoscopic necrosectomy in the bleeding group was more than that in the no-bleeding group (21.6%VS15.1%), the difference between the two groups was not statistically signi cant (P = 0.138); moreover, comparing two groups on different entry points of transluminal endoscopic necrosectomy and percutaneous endoscopic necrosectomy did not show signi cant differences (P > 0.05), which was consistent with the ndings of postoperative bleeding after different entry point debridement compared with previous studies in our center [24]; data from this study found that endoscopic debridement and multiple debridements would not increase bleeding risk, both endoscopic debridement and multiple debridements had no obvious correlation with bleeding, which conformed to our clinical experience that multiple debridements do not cause bleeding, which was also consistent with the recent research ndings in our center [26].…”

“…Reviewing the past studies of our center on 145 cases of endoscopic debridement, it was pointed out that bleeding risk during endoscopic debridement is related to renal failure and it was observed that renal failure may increase the risk of bleeding [24]; however, in our present study, although univariate logistic analysis considered a renal failure and CRRT as in uencing factors, multivariate logistic regression analysis did not consider renal failure as an independent in uencing factor, but CRRT was identi ed as an independent in uencing factor for bleeding (OR: 0.251, 95% CI: 0.094-0.670, P = 0.006). Interestingly, although CRRT may be considered a potential risk factor for bleeding, our combined prediction model showed that CRRT was negatively correlated with bleeding (OR: 0.251 < 1), indicating that it is a protective factor for reducing the risk of bleeding.…”

Risk Factors for Bleeding during Endoscopic Necrosectomy: Are We Wiser Now?

“…8,9 Zheng et al studied 145 patients with ANP who underwent EN and reported that 39 (26.9%) patients experienced postprocedure bleeding. 8 Majority of enrolled patients underwent EN >30 days after the onset of ANP and devices used for EN included basket, snare, and grasping forceps. The majority of patients underwent percutaneous endoscopic necrosectomy, and there was no significant difference between the patients who bled versus those who did not bleed during EN in terms of the necrosectomy approach, timing, or device used.…”

“…In this news and views, we discuss two recently published single-center, retrospective studies from China and the United States that have attempted to elucidate the risk factors for EN. 8,9 Zheng et al studied 145 patients with ANP who underwent EN and reported that 39 (26.9%) patients experienced postprocedure bleeding. 8 Majority of enrolled patients underwent EN >30 days after the onset of ANP and devices used for EN included basket, snare, and grasping forceps.…”