Endoscopy · 2025
Encapsulation levels rather than elapsed time after the onset of acute pancreatitis are related to clinical outcomes of pancreatic walled-off necrosis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Maruta Akinori, Iwashita Takuji, Saito Tomotaka, Gonoi Wataru, Yoshida Kensaku, Omoto Shunsuke, Takenaka Mamoru, Tsujimae Masahiro, Masuda Atsuhiro, Hamada Tsuyoshi, Uemura Shinya, Ota Shogo, Shiomi Hideyuki, Suda Kentaro, Matsubara Saburo, Takahashi Sho, Fujisawa Toshio, Iwasa Yuhei, Iwata Keisuke, Hayashi Nobuhiko, Mukai Tsuyoshi, Isayama Hiroyuki, Yasuda Ichiro, Nakai Yousuke, WONDERFUL study group
Аннотация
BACKGROUND: There is no consensus regarding the optimal timing of endoscopic ultrasound (EUS)-guided interventions for walled-off necrosis (WON) secondary to acute pancreatitis. Currently, intervention timing is primarily determined by the duration after the onset of acute pancreatitis, which potentially serves as a surrogate for fluid collection maturation. We hypothesized that the encapsulation status may be more strongly correlated with clinical outcomes.
METHODS: Between January 2010 and November 2020, 222 patients who underwent EUS-guided WON treatment at 11 centers of the WONDERFUL consortium were included. The patients were divided into two groups based on their encapsulation status at drainage (partial/no vs. complete). The clinical outcomes were compared between groups.
RESULTS: Technical success rates were similar between the groups. Complete encapsulation was associated with a higher clinical success rate (88.1% vs. 52.2%; P<0.001). When patients were classified by both time elapsed and encapsulation status, the encapsulation status was more strongly associated with clinical success. Complete encapsulation was associated with a lower overall adverse event rate (22.7% vs. 39.1%; P=0.04). Overall mortality was significantly higher in the partial/no encapsulation group (34.8% vs. 3.4%; P <0.001). In multivariable analysis, the encapsulation status and diameter of the WON were identified as significant factors associated with clinical success.
CONCLUSIONS: In patients undergoing EUS-guided WON treatment, the encapsulation status, rather than the time elapsed since disease onset, appeared to be more strongly associated with positive clinical outcomes.
METHODS: Between January 2010 and November 2020, 222 patients who underwent EUS-guided WON treatment at 11 centers of the WONDERFUL consortium were included. The patients were divided into two groups based on their encapsulation status at drainage (partial/no vs. complete). The clinical outcomes were compared between groups.
RESULTS: Technical success rates were similar between the groups. Complete encapsulation was associated with a higher clinical success rate (88.1% vs. 52.2%; P<0.001). When patients were classified by both time elapsed and encapsulation status, the encapsulation status was more strongly associated with clinical success. Complete encapsulation was associated with a lower overall adverse event rate (22.7% vs. 39.1%; P=0.04). Overall mortality was significantly higher in the partial/no encapsulation group (34.8% vs. 3.4%; P <0.001). In multivariable analysis, the encapsulation status and diameter of the WON were identified as significant factors associated with clinical success.
CONCLUSIONS: In patients undergoing EUS-guided WON treatment, the encapsulation status, rather than the time elapsed since disease onset, appeared to be more strongly associated with positive clinical outcomes.