Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
Predictors of bleeding during endoscopic necrosectomy: The critical role of device selection favoring snare monotherapy.
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Rao Jingwen, Yang Mei, Liu Haonan, Yang Kunpeng, Wu Jie, Zhu Yong, Xia Liang, Lei Yupeng, Huang Xin, Xiong Huifang, Luo Lingyu, Liu Zhijian, Shu Xu, Zhu Yin, Lu Nonghua, He Wenhua
Аннотация
BACKGROUND: Patients with acute necrotizing pancreatitis (ANP) undergoing endoscopic necrosectomy (EN) are at risk of bleeding associated with the debridement devices used. This study aimed to analyze the bleeding rates associated with different devices and identify predictors of intraprocedural bleeding.
METHODS: In this single-center retrospective study, patients undergoing EN between 2014 and 2022 were categorized by the type of debridement device(s) used. Bleeding rates were compared, and univariate and multivariate logistic regression analyses were conducted to determine independent risk factors.
RESULTS: A total of 969 EN procedures were performed in 447 patients, with intraprocedural bleeding occurring in 175 instances (18.1%). Among single-device applications, the snare demonstrated the lowest bleeding rate (9.8%), significantly lower than the basket (17.9%) and grasping forceps (23.7%) (P < 0.05). The combination of all three devices yielded the highest bleeding rate (30.9%) (P = 0.005). On multivariate analysis, an increase in the number of necrosectomy sessions, the use of grasping forceps, and the combined application of all three devices were independently associated with a significantly higher intraprocedural bleeding rate (P < 0.05 for all). Notably, the majority of bleeding events were successfully managed endoscopically without the need for arterial embolization or surgical intervention.
CONCLUSION: Bleeding rate was higher in patients where a combination of devices was used, and the use of snare appeared safer.
METHODS: In this single-center retrospective study, patients undergoing EN between 2014 and 2022 were categorized by the type of debridement device(s) used. Bleeding rates were compared, and univariate and multivariate logistic regression analyses were conducted to determine independent risk factors.
RESULTS: A total of 969 EN procedures were performed in 447 patients, with intraprocedural bleeding occurring in 175 instances (18.1%). Among single-device applications, the snare demonstrated the lowest bleeding rate (9.8%), significantly lower than the basket (17.9%) and grasping forceps (23.7%) (P < 0.05). The combination of all three devices yielded the highest bleeding rate (30.9%) (P = 0.005). On multivariate analysis, an increase in the number of necrosectomy sessions, the use of grasping forceps, and the combined application of all three devices were independently associated with a significantly higher intraprocedural bleeding rate (P < 0.05 for all). Notably, the majority of bleeding events were successfully managed endoscopically without the need for arterial embolization or surgical intervention.
CONCLUSION: Bleeding rate was higher in patients where a combination of devices was used, and the use of snare appeared safer.