Predictors of the need for necrosectomy in patients with walled-off pancreatic necrosis treated with lumen apposition metal stents
Por:
Gonzalez-Gonzalez, L, Bazaga, S, Murzi, M, Brujats, A, Trias, M, de Riba, B, Romito, R, Colan-Hernandez, J, Concepcion, M, Gordillo, J, Pernas, JC, Poca, M, Soriano, G, Guarner-Argente, C
Publicada:
1 feb 2022
Ahead of Print:
1 mar 2021
Resumen:
Background and aims Endoscopic necrosectomy through lumen apposition metal stents (LAMS) is increasingly being used for complicated walled-off pancreatic necrosis (WOPN), but the need for necrosectomy after stent placement is not well understood. The aim of this study was to evaluate clinical, endoscopic, and radiologic predictors of the need for necrosectomy in patients treated with LAMS. Methods We retrospectively reviewed patients with WOPN treated with LAMS from 2014 to 2017. Necrosectomy was performed only in patients who had recurrent fever or hemodynamic instability during follow-up. Univariate and multivariate analyses were performed. Results We included 15 patients, 67% men and median age was 75 (54-76) years. Two (13%) presented adverse events, one immediate and one delayed. In the first case, the stent migrated to the gastric cavity during deployment but was relocated in the same procedure. In the second case, the patient presented bleeding on day 36 due to a pseudoaneurysm that was successfully treated with embolization. Clinical success was 100%, but five patients (33%) required endoscopic necrosectomy (4 mechanical and 1 irrigation) and one (7%) required surgical necrosectomy of distant collections. The percentage of necrosis in the collection detected in a previous CT scan (45 [35-66]% vs 10 [5-17]%) was the only factor to predict the need for necrosectomy in the multivariate analysis (OR 1.18 [1.01-1.39]). Conclusion LAMS is efficient to treat WOPN but more than a third will need necrosectomy. The percentage of necrosis in the collection detected in the CT scan seems to predict the need for necrosectomy.
Filiaciones:
Gonzalez-Gonzalez, L:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Bazaga, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Murzi, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Brujats, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Trias, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
de Riba, B:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Romito, R:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Colan-Hernandez, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Concepcion, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Gordillo, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Pernas, JC:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Radiol, Barcelona, Spain
Poca, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Soriano, G:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Guarner-Argente, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Gastroenterol, Sant Quinti 89, Barcelona 08041, Spain
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