Long-Term Outcomes of Endoscopic Drainage Modalities in Patients with Pancreatic Fluid Collections Following Acute Pancreatitis: a multicenter retrospective cohort study
Notice bibliographique
Résumé
Aims This study aims to evaluate current practices in managing pancreatic fluid collections, identify trends over time, and assess predictors of clinical improvement and collection resolution following various drainage procedures. Methods An international multicenter cohort study was conducted across three institutions from 2016 to 2023. Patients with radiologically confirmed pancreatic fluid collections were included. The primary outcome was the time to clinical improvement post-drainage, defined as resolution of indications for drainage. Secondary outcomes included complications, readmissions, and rates of collection resolution. Results 403 patients were included in the final analysis. The median age of participants was 56 years (IQR: 24.5), and the cohort was predominantly male (75.8%). Comorbidities included hypertension (41.7%), diabetes (21.3%), and coronary artery disease (16.6%). The most common etiologies of pancreatitis were alcohol misuse disorder (40.0%) and biliary causes (27.8%). Severity classification revealed mild pancreatitis in 46.2%, moderate in 39.0%, and severe in 14.6%. The majority of patients presented with walled-off pancreatic necrosis (62.8%), and 44.7% required drainage due to infection. Endoscopic interventions included lumen-apposing metal stents (46.4%), bi-flanged metal stents (39.2%), and double pigtail stents (12.5%). Adverse events were rare, with a bleeding rate of 0.25% and a stent migration rate of 1.99%. At follow-up, 79.4% of patients achieved resolution of fluid collections, with a total follow-up time of 192.6 person-years and a median follow-up of 190 days (IQR: 267.5). The overall resolution rate was 76.4%. Reintervention was required in 24.8% of patients, with 55% of these requiring endoscopic re-stenting. The median time to reintervention was 108 days (IQR: 244). Factors associated with faster recovery after drainage, as identified through Cox regression, included LAMS placement (HR=1.8, [1.44, 2.35], P<0.001) and peripancreatic involvement only (HR=1.2, [1.02, 1.31], P=0.02). Older age, female sex, and the location of the procedure were not significantly associated with recovery time (Age: HR=1.0, [0.99, 1.01], P=0.43; Sex: HR=1.1, [0.85, 1.37], P=0.53). Factors predictive of longer resolution times included repeat pancreatitis (HR=0.56, [0.37, 0.83], P=0.004), multiorgan failure (HR=0.45, [0.27, 0.76], P=0.003), and walled-off necrosis as the type of pancreatic fluid collection (HR=0.75, [0.59, 0.94], P=0.01). Predictors of procedure failure, identified through logistic regression, included age (OR=1.0, [1.00, 1.03], P=0.06), multi-organ failure (OR=6.3, [3.04, 13.18], P<0.001), and walled-off necrosis (OR=2.54, [1.41, 4.57], P=0.002). Factors associated with improvement included biliary (OR=0.39, [0.21, 0.75], P=0.005) and chronic pancreatitis etiology (OR=0.48, [0.02, 0.23], P<0.001) [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ]. Conclusions In conclusion, our study underscores the complexity of managing pancreatic fluid collections, emphasizing the role of timely interventions and stenting strategies in clinical outcomes. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».