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Peng S, Yao Q, Fu Y, Xu X, Chen S, Ke H, Hu Y, Xiong H, He W, Zhu Y, Xia L, Wu Y, Shu X, Liu Z, Zhu Y, Chen Y, Lu N, Liu P. The severity and infection of acute pancreatitis may increase the risk of bleeding in patients undergoing EUS-guided drainage and endoscopic necrosectomy: a large retrospective cohort. Surg Endosc 2023:10.1007/s00464-023-10059-0. [PMID: 37188909 DOI: 10.1007/s00464-023-10059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/01/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND There has been great progress in the use of endoscopic ultrasound (EUS)-guided drainage in acute pancreatitis patients using a novel lumen-apposing metal stent (LAMS) in the last decade, but some patients experience bleeding. Our research analyzed the preprocedural risk factors for bleeding. METHODS From July 13, 2016 to June 23, 2021, we retrospectively analyzed all patients who received endoscopic drainage by the LAMS in our hospital. Univariate and multivariate statistical analyses were used to identify the independent risk factors. We plotted ROC curves based on the independent risk factors. RESULTS A total of 205 patients were analyzed and 5 patients were excluded. A total of 200 patients were included in our research. Thirty (15%) patients presented with bleeding. In the multivariate analysis, computed tomography severity index score (CTSI) score [odds ratio (OR), 2.66; 95% CI: 1.31-5.38; P = 0.007], positive blood cultures [odds ratio (OR), 5.35; 95% CI: 1.31-21.9; P = 0.02], and Acute Physiology and Chronic Health Evaluation II (APACHE II) score [odds ratio (OR), 1.14; 95% CI: 1. 01-1.29; P = 0.045] were associated with bleeding. The area under the ROC curve of the combined predictive indicator was 0.79. CONCLUSION Bleeding in endoscopic drainage by the LAMS is significantly associated with the CTSI score, positive blood cultures, and APACHE II score. This result could help clinicians make more appropriate choices.
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Affiliation(s)
- Siyang Peng
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Yao
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunfeng Fu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Xu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - SiHai Chen
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huajing Ke
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yang Hu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huifang Xiong
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenhua He
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Zhu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liang Xia
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yao Wu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xu Shu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhijian Liu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yin Zhu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Youxiang Chen
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nonghua Lu
- Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Pi Liu
- Department of Gastroenterology, Affiliated Longhua People's Hospital, Southern Medical University, Shenzhen, 518109, China.
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Dhaka N, Sinha SK, Samanta J, Gupta V, Yadav TD, Gulati A, Kochhar R. Impact of the site of necrosis on outcome of acute pancreatitis. JGH OPEN 2018; 2:295-299. [PMID: 30619940 PMCID: PMC6308040 DOI: 10.1002/jgh3.12087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/20/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022]
Abstract
Objecives To compare the clinical outcome of patients with extrapancreatic necrosis (EXPN) alone with that of acute interstitial pancreatitis (AIP), pancreatic parenchymal necrosis (PPN) alone, and combined PPN and EXPN. Background There are only a few studies in the literature in which EXPN has been recently recognized as a subtype of acute necrotizing pancreatitis (ANP), with a better prognosis. Methods We analyzed clinical data and outcome variables of 411 consecutive acute pancreatitis (AP) patients between January 2012 and December 2014. Contrast‐enhanced computed tomography (CECT) images of each patient were reviewed and characterized as AIP or ANP. Patients with ANP were divided into EXPN alone, PPN alone, and combined PPN and EXPN. Outcome variables were then compared between these groups. Results Of the 411 patients, 74 (18%) had AIP, and 337 (82%) had ANP. Patients with EXPN alone (n = 40; 11.8%) had similar outcomes as patients with PPN alone (n = 12; 3.5%); however, their outcome was worse than that of patients with AIP, with a higher frequency of persistent organ failure (POF), need for percutaneous catheter drainage (PCD), and longer length of hospitalization (LOH). Patients with combined PPN and EXPN (n = 285; 84.7%) had the worst clinical course, with higher frequency of POF, infected necrosis, intervention requirement, and longer LOH. Conclusion Patients with combined PPN and EXPN have a severe disease course with the worst clinical outcomes; patients with AIP patients have the most benign course, while patients with EXPN alone stand between the two extremes of disease course with an intermediate grade of severity.
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Affiliation(s)
- Narendra Dhaka
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Saroj K Sinha
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Jayanta Samanta
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vikas Gupta
- Department of Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Thakur Deen Yadav
- Department of Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Ajay Gulati
- Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Rakesh Kochhar
- Department of Gastroenterology Postgraduate Institute of Medical Education and Research Chandigarh India
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