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The severity and infection of acute pancreatitis may increase the risk of bleeding in patients undergoing EUS-guided drainage and endoscopic necrosectomy: a large retrospective cohort

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Abstract

Background

There has been great progress in the use of endoscopic ultrasound (EUS)-guided drainage in acute pancreatitis patients using a novel lumen-apposing metal stent (LAMS) in the last decade, but some patients experience bleeding. Our research analyzed the preprocedural risk factors for bleeding.

Methods

From July 13, 2016 to June 23, 2021, we retrospectively analyzed all patients who received endoscopic drainage by the LAMS in our hospital. Univariate and multivariate statistical analyses were used to identify the independent risk factors. We plotted ROC curves based on the independent risk factors.

Results

A total of 205 patients were analyzed and 5 patients were excluded. A total of 200 patients were included in our research. Thirty (15%) patients presented with bleeding. In the multivariate analysis, computed tomography severity index score (CTSI) score [odds ratio (OR), 2.66; 95% CI: 1.31–5.38; P = 0.007], positive blood cultures [odds ratio (OR), 5.35; 95% CI: 1.31–21.9; P = 0.02], and Acute Physiology and Chronic Health Evaluation II (APACHE II) score [odds ratio (OR), 1.14; 95% CI: 1. 01–1.29; P = 0.045] were associated with bleeding. The area under the ROC curve of the combined predictive indicator was 0.79.

Conclusion

Bleeding in endoscopic drainage by the LAMS is significantly associated with the CTSI score, positive blood cultures, and APACHE II score. This result could help clinicians make more appropriate choices.

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Funding

This work was supported by the National Natural Science Foundation of China (81860123) and Science and Technology Plan of Jiangxi Provincial Health Commission (202130299).

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Authors and Affiliations

  1. Department of Gastroenterology, Pancreatic Disease Centre, First Affiliated Hospital of Nanchang University, Nanchang, China

    Siyang Peng, Qian Yao, Yunfeng Fu, Xuan Xu, SiHai Chen, Huajing Ke, Yang Hu, Huifang Xiong, Wenhua He, Yong Zhu, Liang Xia, Yao Wu, Xu Shu, Zhijian Liu, Yin Zhu, Youxiang Chen & Nonghua Lu

  2. Department of Gastroenterology, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518109, China

    Pi Liu

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  1. Siyang Peng
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Contributions

All authors contributed to meet all four requirements of ICJME recommendations. Ideas and designs are proposed by PL. Data acquisition and analysis are done by SP, QY, and YF. Manuscript writing and revision were contributed by SP, PL, QY, YF, XX, SHC, HK, YH, HX, WH, YW, XS, ZL, LX, YZ, YC, and NL. All authors contributed to data acquisition and analysis, manuscript writing and revising, and agreed all aspects of the work. The corresponding author, PL, confirms that he had full access to the data and the final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Pi Liu.

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Disclosure

The authors Siyang Peng, Qian Yao, Yunfeng Fu, Xuan Xu, SiHai Chen, Huajing Ke, Yang Hu, Huifang Xiong, Wenhua He, Yong Zhu, Liang Xia, Yao Wu, Xu Shu, Zhijian Liu, Liang Xia, Yin Zhu, Youxiang Chen, and Nonghua Lu, and Pi Liu have no conflicts of interest or financial ties to disclose.

Ethical approval

The study received ethical approval from the First Affiliated Hospital of Nanchang University Institutional Ethics Review Committee.

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Peng, S., Yao, Q., Fu, Y. et al. The severity and infection of acute pancreatitis may increase the risk of bleeding in patients undergoing EUS-guided drainage and endoscopic necrosectomy: a large retrospective cohort. Surg Endosc 37, 6246–6254 (2023). https://doi.org/10.1007/s00464-023-10059-0

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