Pancreas

Clin Gastroenterol Hepatol. 2023;21(10):2543–50.e1

Baroud S, Chandrasekhara V, Storm AC, Law RJ, Vargas EJ, Levy MJ, Mahmoud T, Bazerbachi F, Bofill-Garcia A, Ghazi R, Maselli DB, Martin JA, Vege SS, Takahashi N, Petersen BT, Topazian MD, Abu Dayyeh BK

A protocolized management of walled-off necrosis (WON) reduces time to WON resolution and improves outcomes

Background and aims: Patients with infected or symptomatic walled-off necrosis (WON) have high morbidity and health care utilization. Despite the recent adoption of non-surgical treatment approaches, WON management remains non-algorithmic. The authors investigated the impact of a protocolized early necrosectomy approach compared with a non-protocolized, clinician-driven approach on important clinical outcomes.
Methods: Records were reviewed for consecutive patients with WON who underwent a protocolized endoscopic drainage with a lumen-apposing metal stent (LAMS; cases), and for patients with WON treated with a LAMS at the same tertiary referral center who were not managed according to the protocol (control subjects). The protocol required repeat cross-sectional imaging within 14 days after LAMS placement, with regularly scheduled endoscopic necrosectomy if WON diameter reduction was < 50%. Control patients were treated according to their clinician’s preference without an a priori strategy. Inverse probability of treatment weighting-adjusted analysis was used to evaluate the influence of being in the protocolized group on time to resolution.
Results: A total of 24 cases and 47 control subjects were included. There were no significant differences in baseline characteristics. Although numbers of endoscopies and necrosectomies were similar, cases had lower adverse event rates, shorter intensive care unit stay, and required nutritional support for fewer days. On matched multivariate Cox regression, cases had earlier WON resolution (hazard ratio [HR] = 5.73; 95% confidence interval [CI]: 2.62–12.5). This was confirmed in the inverse probability of treatment weighting-adjusted analysis (HR = 3.4; 95% CI: 1.92–6.01).

Conclusions: A protocolized strategy resulted in faster walled-off necrosis resolution compared with a discretionary approach without the need for additional therapeutic interventions, and with a better safety profile and decreased health care utilization.

B.K. Abu Dayyeh, M.D., Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA, E-Mail: abudayyeh.barham@mayo.edu

DOI: 10.1016/j.cgh.2023.04.029

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Pancreas

Patient selection for urgent endoscopic retrograde cholangiopancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): A multicenter prospective study

Gut. 2023;72(8):1534–42

Hallensleben ND, Stassen PMC, Schepers NJ, Besselink MG, Anten MPGF, Bakker OJ, Bollen TL, da Costa DW, van Dijk SM, van Dullemen HM, Dijkgraaf MGW, van Eijck B, van Eijck CHJ, Erkelens W, Erler NS, Fockens P, van Geenen EJM, van Grinsven J, Hazen WL, Hollemans RA, van Hooft JE, Jansen JM, Kubben FJGM, Kuiken SD, Poen AC, Quispel R, de Ridder RJ, Römkens TEH, Schoon EJ, Schwartz MP, Seerden TCJ, Smeets XJNM, Spanier BWM, Tan ACITL, Thijs WJ, Timmer R, Umans DS, Venneman NG, Verdonk RC, Vleggaar FP, van de Vrie W, van Wanrooij RLJ, Witteman BJ, van Santvoort HC, Bouwense SAW, Bruno MJ; Dutch Pancreatitis Study Group

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Pancreas

Detailed characteristics of post-discharge mortality in acute pancreatitis

Gastroenterology. 2023;165(3):682–95