Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas.
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2192-2198. doi: 10.1016/j.cgh.2021.05.005. Epub 2021 Jun 2.
BACKGROUND & AIMS: A significant proportion of individuals with pancreatic fluid collections (PFCs) require step-up therapy after endoscopic drainage with lumen-apposing metal stents. The aim of this study is to identify factors associated with PFCs that require step-up therapy.
A retrospective cohort study of patients undergoing endoscopic ultrasound-guided drainage of PFCs with lumen-apposing metal stents from April 2014 to October 2019 at a single center was performed. Step-up therapy included direct endoscopic necrosectomy, additional drainage site (endoscopic or percutaneous), or surgical intervention after the initial drainage procedure. Multivariable logistic regression was performed using a backward stepwise approach with a P ≤ .2 threshold for variable retention to identify factors predictive for the need for step-up therapy.
One hundred thirty-six patients were included in the final study cohort, of whom 69 (50.7%) required step-up therapy. Independent predictors of step-up therapy included: collection size measuring ≥10 cm (odds ratio [OR], 8.91; 95% confidence interval [CI], 3.36-23.61), paracolic extension of the PFC (OR, 4.04; 95% CI, 1.60-10.23), and ≥30% solid necrosis (OR, 4.24; 95% CI, 1.48-12.16). In a sensitivity analysis of 81 patients with walled-off necrosis, 51 (63.0%) required step-up therapy. Similarly, factors predictive of the need for step-up therapy for walled-off necrosis included: collection size measuring ≥10 cm (OR, 6.94; 95% CI, 1.76-27.45), paracolic extension of the PFC (OR, 3.79; 95% CI, 1.18-12.14), and ≥30% solid necrosis (OR, 7.10; 95% CI, 1.16-43.48).
Half of all patients with PFCs drained with lumen-apposing metal stents required step-up therapy, most commonly direct endoscopic necrosectomy. Individuals with PFCs ≥10 cm in size, paracolic extension, or ≥30% solid necrosis are more likely to require step-up therapy and should be considered for early endoscopic reintervention.
相当一部分胰腺液体积聚（PFCs）患者在接受内镜下引流和使用腔内镜金属支架治疗后需要进行升级治疗。本研究旨在确定与需要升级治疗的 PFCs 相关的因素。
对 2014 年 4 月至 2019 年 10 月在一家单中心接受内镜超声引导下引流 PFCs 并使用腔内镜金属支架治疗的患者进行回顾性队列研究。升级治疗包括直接内镜下坏死组织清除术、额外引流部位（内镜或经皮）或初次引流后进行手术干预。使用向后逐步法进行多变量逻辑回归，保留变量的 P 值≤0.2，以确定预测需要升级治疗的因素。
本研究最终纳入 136 例患者，其中 69 例（50.7%）需要升级治疗。升级治疗的独立预测因素包括：积聚物大小≥10cm（比值比[OR]，8.91；95%置信区间[CI]，3.36-23.61）、积聚物位于结肠旁（OR，4.04；95% CI，1.60-10.23）和≥30%实性坏死（OR，4.24；95% CI，1.48-12.16）。在 81 例患有隔离性坏死的患者的敏感性分析中，51 例（63.0%）需要升级治疗。同样，预测隔离性坏死需要升级治疗的因素包括：积聚物大小≥10cm（OR，6.94；95% CI，1.76-27.45）、积聚物位于结肠旁（OR，3.79；95% CI，1.18-12.14）和≥30%实性坏死（OR，7.10；95% CI，1.16-43.48）。
所有接受腔内镜金属支架引流的 PFCs 患者中有一半需要升级治疗，最常见的是直接内镜下坏死组织清除术。积聚物大小≥10cm、结肠旁延伸或≥30%实性坏死的患者更有可能需要升级治疗，应考虑早期内镜再干预。
