Computed Tomography Imaging-based Predictors of the Need for a Step-up Approach After Initial Endoscopic Ultrasound-guided Transmural Drainage for Pancreatic Fluid Collections

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2022 Sep 19

PMID 36123547

Authors

Masahiro Tsujimae

Hideyuki Shiomi

Arata Sakai

Atsuhiro Masuda

Noriko Inomata

Shinya Kohashi

Kae Nagao

Hisahiro Uemura

Shigeto Masuda

Masanori Gonda

Shohei Abe

Shigeto Ashina

Kohei Yamakawa

Takeshi Tanaka

Ryota Nakano

Takashi Kobayashi

Yuzo Kodama

Affiliations

Soon will be listed here.

Abstract

Background: A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD.

Methods: This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD.

Results: We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68-97.6, P = 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91-136.1, P = 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33-29.3, P = 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs.

Conclusion: Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings.

Clinical Registration Number: UMIN 000030898.

Citing Articles

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

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PMID: 37485492 PMC: 10357067. DOI: 10.1177/17562848231180047.

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