Predicting the need for step-up after EUS-guided drainage of peripancreatic fluid collections, including Quadrant-Necrosis-Infection score validation: a prospective cohort study

IF 7.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gastrointestinal endoscopy Pub Date : 2025-09-01 Epub Date: 2025-01-20 DOI:10.1016/j.gie.2025.01.019

Giuseppe Vanella MD, PhD , Roberto Leone MD , Francesco Frigo MD , Gemma Rossi MD , Piera Zaccari MD, PhD , Diego Palumbo MD, PhD , Giorgia Guazzarotti MD , Francesca Aleotti MD , Nicolò Pecorelli MD , Paoletta Preatoni MD , Luca Aldrighetti MD, PhD , Massimo Falconi MD , Gabriele Capurso MD, PhD , Francesco De Cobelli MD , Paolo Giorgio Arcidiacono MD, FASGE

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Abstract

Background and Aims

Factors predicting the need for step-up procedures after endoscopic ultrasound (EUS)–guided fluid collection drainage (EUS-FCD) of peripancreatic fluid collections (PFCs) were explored in retrospective studies restricted to walled-off necrosis (WON) and lumen-apposing metal stents (LAMSs).

Methods

All consecutive candidates for EUS-FCD from 2020 to 2024 were included in a Prospective Registry of Therapeutic EUS (PROTECT, NCT04813055), with prospective monthly follow-up evaluating clinical success, adverse events, and recurrences. Prospectively assessed baseline clinical and morphologic factors, including the Quadrant-Necrosis-Infection (QNI) classification, were included in a stepwise logistic regression model to predict the need for step-up. The agreement between EUS and radiology in assessing the extent of necrosis was compared with the use of Cohen’s kappa.

Results

Seventy patients (29 postsurgical collections, 21 pseudocysts, and 20 WONs) were treated with double-pigtail plastic stents (DPPSs) in 59% of cases and LAMSs in 41%. Clinical success was 92.9%, with a need for step-up (mostly endoscopic necrosectomy) in 35.7% of cases. Necrosis ≥60% (odds ratio [OR], 7.7; 95% confidence interval [CI], 1.4-43) and being in the high-risk QNI group (OR, 4.6; 95% CI, 1.4-15) were the only independent predictors of any step-up. The same factors predicted the endoscopist’s decision to allocate PFCs to LAMSs vs DPPSs. The high-risk QNI group was associated with a significantly longer hospital stay (12 days vs 4 days; P = .004). EUS tended to upscale the necrotic content compared with preprocedural radiology (κ = 0.31).

Conclusions

The extent of necrosis and the QNI classification strongly correlated with the need for step-up and allocation to LAMS versus DPPS drainage, suggesting a central role in treatment personalization.

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预测eus引导胰周积液引流后需要加强治疗，包括象限坏死感染评分验证：一项前瞻性队列研究

背景和目的：在局限于壁状坏死（WON）和腔内金属支架（LAMS）的回顾性研究中，探讨了eus引导下胰周液收集（pfc）引流（EUS-FCD）后预测需要加强手术的因素。方法：2020-2024年期间所有连续EUS- fcd候选患者纳入治疗性EUS前瞻性登记（PROTECT, NCT04813055），前瞻性每月随访评估临床成功、不良事件和复发。前瞻性评估的基线临床和形态学因素，包括象限坏死感染（QNI）分类，被纳入逐步逻辑回归模型，以预测是否需要升级。用Cohen kappa法比较EUS和影像学在评估坏死程度上的一致性。结果：70例患者（术后收集29例，假性囊肿21例，WONs 20例）采用双尾塑料支架（DPPS）治疗（59%），LAMS治疗（41%）。临床成功率为92.9%，35.7%的病例需要进一步手术（主要是内窥镜下坏死切除术）。坏死≥60% （OR=7.7, 95%CI 1.4-43）和属于QNI高危组（OR=4.6, 95%CI 1.4-15）是任何加重的唯一独立预测因子。同样的因素预测了内窥镜医师将pfc分配给LAMS和DPPS的决定。QNI高危组的住院时间明显较长（12天对4天，p=0.004）。与术前放射学相比，EUS倾向于增加坏死内容（κ=0.31）。结论：坏死程度和QNI分级与需要加强和分配LAMS与DPPS引流密切相关，表明在治疗个性化中起核心作用。

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.