Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
Re-intervention in endoscopic ultrasound-guided walled-off necrosis drainage with metal stents: Identifying high-risk morphologies.
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Jagtap Nitin, Koduri Krithi Krishna, Memon Sana Fathima, Inavolu Pradev, Lakhtakia Sundeep, Asif Shujaath, Basha Jahangeer, Talukdar Rupjyoti, Ramchandani Mohan, Kalapala Rakesh, Sreekanth Vivek, Singh Jagdeesh R, Putta Tharani, Rao G Venkat, Reddy D Nageshwar
Аннотация
BACKGROUND AND OBJECTIVE: Endoscopic ultrasound (EUS)-guided drainage with metal stents is a standard therapy for walled-off necrosis (WON). However, some patients require re-interventions such as stent unclogging, necrosectomy or percutaneous drainage. This study aimed at identifying predictors of re-intervention to facilitate risk stratification and optimize management.
METHODS: This study included consecutive patients who underwent EUS-guided WON drainage with metal stents between January 2023 and December 2024 at a tertiary referral center. Demographic, clinical and radiological data was collected prospectively. Multi-variate logistic regression identified independent predictors of re-intervention. Model performance was evaluated using receiver operating characteristic (ROC) curve, calibration plot and decision curve analysis. Model's diagnostic performance was evaluated in the validation cohort.
RESULTS: Of 500 patients (83.2% male), 28.6% had alcohol-related and 10% had biliary pancreatitis. Re-intervention was required in 24% (n = 120), primarily for stent unclogging (85.8%), nasocystic tube placement (70%) and necrosectomy (50%). Independent predictors of re-intervention included WON size (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.25-1.52), paracolic extension (OR 9.96; 95% CI, 1.77-55.98) and solid debris content (OR 1.10; 95% CI, 1.08-1.13). The model demonstrated good discrimination (area under the curve [AUC] = 0.85) and calibration (Hosmer-Lemeshow p = 0.19). The overall accuracy of the model in the validation cohort was 86.67% (95% CI, 73.21-94.95%). Adverse events occurred in 6% of patients, including bleeding (n = 11), stent migration (n = 13) and sepsis-related death (n = 6).
CONCLUSION: Larger WON size, paracolic extension and higher solid debris content are independent predictors of re-intervention after EUS-guided drainage. Early identification of these factors may allow for individualized step-up therapy and improved clinical outcomes.
METHODS: This study included consecutive patients who underwent EUS-guided WON drainage with metal stents between January 2023 and December 2024 at a tertiary referral center. Demographic, clinical and radiological data was collected prospectively. Multi-variate logistic regression identified independent predictors of re-intervention. Model performance was evaluated using receiver operating characteristic (ROC) curve, calibration plot and decision curve analysis. Model's diagnostic performance was evaluated in the validation cohort.
RESULTS: Of 500 patients (83.2% male), 28.6% had alcohol-related and 10% had biliary pancreatitis. Re-intervention was required in 24% (n = 120), primarily for stent unclogging (85.8%), nasocystic tube placement (70%) and necrosectomy (50%). Independent predictors of re-intervention included WON size (odds ratio [OR] 1.38; 95% confidence interval [CI], 1.25-1.52), paracolic extension (OR 9.96; 95% CI, 1.77-55.98) and solid debris content (OR 1.10; 95% CI, 1.08-1.13). The model demonstrated good discrimination (area under the curve [AUC] = 0.85) and calibration (Hosmer-Lemeshow p = 0.19). The overall accuracy of the model in the validation cohort was 86.67% (95% CI, 73.21-94.95%). Adverse events occurred in 6% of patients, including bleeding (n = 11), stent migration (n = 13) and sepsis-related death (n = 6).
CONCLUSION: Larger WON size, paracolic extension and higher solid debris content are independent predictors of re-intervention after EUS-guided drainage. Early identification of these factors may allow for individualized step-up therapy and improved clinical outcomes.