Predictors of bleeding during endoscopic necrosectomy: The critical role of device selection favoring snare monotherapy

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2026-05-01 Epub Date: 2026-03-25 DOI:10.1016/j.pan.2026.03.013

Jingwen Rao, Mei Yang, Haonan Liu, Kunpeng Yang, Jie Wu, Yong Zhu, Liang Xia, Yupeng Lei, Xin Huang, Huifang Xiong, Lingyu Luo, Zhijian Liu, Xu Shu, Yin Zhu, Nonghua Lu, Wenhua He

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引用次数: 0

Abstract

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.

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内镜下坏死切除术出血的预测因素：器械选择对陷阱单一治疗的关键作用。

背景：急性坏死性胰腺炎（ANP）患者接受内镜下坏死性切除术（EN）有出血的风险，与使用的清创装置相关。本研究旨在分析与不同装置相关的出血率，并确定术中出血的预测因素。方法：在这项单中心回顾性研究中，根据使用的清创器类型对2014年至2022年间接受EN手术的患者进行分类。比较出血率，并进行单因素和多因素logistic回归分析以确定独立危险因素。结果：447例患者共进行969次EN手术，175例（18.1%）发生术中出血。在单器械应用中，圈套出血率最低（9.8%），显著低于筐（17.9%）和抓钳（23.7%）（P < 0.05）。三种器械联合使用出血率最高（30.9%）（P = 0.005）。在多因素分析中，坏死切除术次数的增加、抓钳的使用以及所有三种器械的联合应用与术中出血率的显著升高独立相关（P < 0.05）。值得注意的是，大多数出血事件都是在内窥镜下成功处理的，不需要动脉栓塞或手术干预。结论：联合使用器械的患者出血率较高，圈套的使用更安全。

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

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.