TY - JOUR
T1 - Radiologic Predictors of Increased Number of Necrosectomies During Endoscopic Management of Walled-off Pancreatic Necrosis
AU - Cosgrove, Natalie
AU - Shetty, Anup
AU - McLean, Richard
AU - Vitta, Swaroop
AU - Faisal, Mir F.
AU - Mahmood, Sultan
AU - Early, Dayna
AU - Mullady, Dan
AU - Das, Koushik
AU - Lang, Gabriel
AU - Thai, Theresa
AU - Syed, Taseen
AU - Maple, John
AU - Jonnalagadda, Sreeni
AU - Andresen, Kelli
AU - Hollander, Thomas
AU - Kushnir, Vladimir
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Goals: No established methods exist to predict who will require a higher number of endoscopic necrosectomy sessions for walled-off necrosis (WON). We aim to identify radiologic predictors for requiring a greater number of necrosectomy sessions. This may help to identify patients who benefit from aggressive endoscopic management. Materials and Methods: This is a multicenter retrospective study of patients with WON at 3 tertiary care centers. WON characteristics on preintervention computed tomography imaging were evaluated to determine if they were predictive of requiring more endoscopic necrosectomy. Results: A total of 104 patients were included. Seventy patients (67.3%) underwent endoscopic necrosectomy, with median of 2 necrosectomies. WON largest transverse diameters (P=0.02), largest coronal diameters (P=0.01), necrosis pattern [likelihood ratio (LR)=17.85, P<0.001], spread (LR=11.02, P=0.01), hemorrhage (LR=8.64, P=0.003), and presence of disconnected pancreatic duct (LR=6.80, P=0.01) were associated with undergoing ≥2 necrosectomies. Patients with septations/loculations were significantly less likely to undergo ≥2 necrosectomies (LR=4.86, P=0.03). Conclusions: Several computed tomography radiologic features were significantly associated with undergoing ≥2 necrosectomies. These could help identify patients who will undergo a higher number of endoscopic necrosectomy sessions.
AB - Goals: No established methods exist to predict who will require a higher number of endoscopic necrosectomy sessions for walled-off necrosis (WON). We aim to identify radiologic predictors for requiring a greater number of necrosectomy sessions. This may help to identify patients who benefit from aggressive endoscopic management. Materials and Methods: This is a multicenter retrospective study of patients with WON at 3 tertiary care centers. WON characteristics on preintervention computed tomography imaging were evaluated to determine if they were predictive of requiring more endoscopic necrosectomy. Results: A total of 104 patients were included. Seventy patients (67.3%) underwent endoscopic necrosectomy, with median of 2 necrosectomies. WON largest transverse diameters (P=0.02), largest coronal diameters (P=0.01), necrosis pattern [likelihood ratio (LR)=17.85, P<0.001], spread (LR=11.02, P=0.01), hemorrhage (LR=8.64, P=0.003), and presence of disconnected pancreatic duct (LR=6.80, P=0.01) were associated with undergoing ≥2 necrosectomies. Patients with septations/loculations were significantly less likely to undergo ≥2 necrosectomies (LR=4.86, P=0.03). Conclusions: Several computed tomography radiologic features were significantly associated with undergoing ≥2 necrosectomies. These could help identify patients who will undergo a higher number of endoscopic necrosectomy sessions.
KW - endoscopic necrosectomy
KW - pancreatic fluid collections
KW - radiologic predictors
KW - walled-off pancreatic necrosis
UR - http://www.scopus.com/inward/record.url?scp=85128488857&partnerID=8YFLogxK
U2 - 10.1097/MCG.0000000000001549
DO - 10.1097/MCG.0000000000001549
M3 - Article
C2 - 33883512
AN - SCOPUS:85128488857
SN - 0192-0790
VL - 56
SP - 457
EP - 463
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
IS - 5
ER -