Immediate Direct Endoscopic Necrosectomy Versus Delayed Direct Endoscopic Necrosectomy

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy Pub Date : 2024-01-01 DOI:10.1016/j.tige.2024.06.008

Abdullah A. Al-Shahrani , Benjamin W. Warren , Samuel Han , Steven A. Edmundowicz , Mihir S. Wagh , Sachin B. Wani , Hazem T. Hammad , Augustin R. Attwell , Raj J. Shah

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引用次数: 0

Abstract

BACKGROUND AND AIMS

Lumen-apposing metal stents (LAMSs) are effective in resolving walled-off necrosis (WON) of the pancreas and enable direct endoscopic necrosectomy (DEN). However, optimal DEN timing is controversial. We aimed to study if early DEN shortens WON resolution time.

METHODS

We retrospectively reviewed patients who underwent LAMS placement for WON at a tertiary center. We collected patient demographics, WON characteristics, DEN sessions, and outcomes. We compared those who underwent immediate DEN (iDEN; index DEN at LAMS placement) and delayed DEN (dDEN; index DEN on a separate day from LAMS placement). We identified predictors for resolution time via linear regression, and constructed Nelson-Aalen cumulative hazards curves showing resolution time stratified by index DEN timing.

RESULTS

Between January 2011 and June 2019, 175 patients underwent LAMS placement for peripancreatic fluid collections, 155 (88.6%) of which were WON. Of these, 50 (32.3%) required DEN. The majority were male (80%) with an average age of 52.5 years. WON size and double-pigtail stent use through LAMS were similar. Overall, the mean time to WON resolution was 90.6 days, 44.5 (iDEN) versus 100.7 (dDEN), P = 0.02, with similar DEN sessions (P = 0.64). The average length of stay was 0.9 in iDEN versus 14.7 days in dDEN (P = 0.03). All had WON resolution with a similar adverse event rate (18.5% iDEN vs 25.1% dDEN, P = 0.45). In multivariate analysis, double-pigtail stent use suggested greater complexity and longer WON resolution time (P = 0.005).

CONCLUSION

Despite similar DEN sessions, LAMS with iDEN significantly reduced resolution time compared with dDEN. Only one-third of WON patients treated with LAMS placement required DEN.

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即刻直接内镜坏死组织切除术与延迟直接内镜坏死组织切除术的比较

背景和目的腔内金属支架（LAMS）能有效解决胰腺贴壁坏死（WON），并能直接进行内镜下坏死切除术（DEN）。然而，最佳的内镜下坏死切除术时机尚存争议。我们的目的是研究早期 DEN 是否能缩短 WON 的解决时间。方法我们回顾性分析了在一家三级中心接受 LAMS 置入术治疗 WON 的患者。我们收集了患者的人口统计学特征、WON特征、DEN疗程和结果。我们比较了立即进行 DEN（iDEN；在 LAMS 置入时进行指数 DEN）和延迟进行 DEN（dDEN；在 LAMS 置入后的另一天进行指数 DEN）的患者。结果2011年1月至2019年6月期间，175名患者因胰周积液接受了LAMS置管，其中155人（88.6%）为WON。其中 50 人（32.3%）需要进行 DEN。大多数患者为男性（80%），平均年龄为 52.5 岁。WON 大小和通过 LAMS 使用双辫支架的情况相似。总体而言，WON解决的平均时间为90.6天，44.5天（iDEN）对100.7天（dDEN），P = 0.02，DEN疗程相似（P = 0.64）。iDEN的平均住院时间为0.9天，而dDEN为14.7天（P = 0.03）。所有患者都解决了 WON 问题，不良事件发生率相似（iDEN 为 18.5% 对 dDEN 为 25.1%，P = 0.45）。在多变量分析中，使用双辫支架表明手术更复杂，WON解决时间更长（P = 0.005）。结论尽管DEN疗程相似，但与dDEN相比，使用iDEN的LAMS显著缩短了解决时间。只有三分之一接受 LAMS 置入治疗的 WON 患者需要 DEN。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques and Innovations in Gastrointestinal Endoscopy Medicine-Gastroenterology

CiteScore

2.10

自引率

50.00%

发文量