Predictive Value of Computed Tomography Scans and Clinical Findings for the Need of Endoscopic Necrosectomy in Walled-off Necrosis From Pancreatitis. Issue 8 (September 2017)

• Record Type: Journal Article
• Authors: Finkelmeier, Fabian; Sturm, Christian; Friedrich-Rust, Mireen; Bojunga, Jörg; Sarrazin, Christoph; Tal, Andrea; Hausmann, Johannes; Zeuzem, Stefan; Zangos, Stephan; Albert, Jörg; Farnik, Harald
• Is Part Of: Pancreas. Volume 46:Issue 8(2017)
• Publication Date: 2017-09
• Subjects: endoscopic-retrograde cholangio-pancreatography -- endoscopy -- pancreatitis -- pancreatic cysts -- walled-off necrosis -- pseudocysts -- necrosectomy -- AP - acute pancreatitis -- ANP - acute necrotizing pancreatitis -- CI - confidence interval -- ceCT - contrast-enhanced computed tomography -- COPD - chronic obstructive pulmonary disease -- ERCP - endoscopic retrograde cholangiopancreatography -- HU - Hounsfield units -- OR - odds ratio -- WON - walled-off necrosis; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000000881
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: Choosing the best treatment option at the optimal point of time for patients with walled-off necrosis (WON) is crucial. We aimed to identify imaging parameters and clinical findings predicting the need of necrosectomy in patients with WON. Methods: All patients with endoscopically diagnosed WON and pseudocyst were retrospectively identified. Post hoc analysis of pre-interventional contrast-enhanced computed tomography was performed for factors predicting the need of necrosectomy. Results: Sixty-five patients were included in this study. Forty patients (61.5%) were diagnosed with pseudocyst and 25 patients (38.5%) with WON. Patients with WON mostly had acute pancreatitis with biliary cause compared with more chronic pancreatitis and toxic cause in pseudocyst group ( P = 0.002 and P = 0.004, respectively). Logistic regression revealed diabetes as a risk factor for WON. Computed tomography scans revealed 4.62% (n = 3) patients as false positive and 24.6% (n = 16) as false negative findings for WON. Reduced perfusion and detection of solid findings were independent risk factors for WON. Conclusions: Computed tomography scans are of low diagnostic yield when needed to predict treatment of patients with pancreatic cysts. Reduced pancreatic perfusion and solid findings seem to be a risk factor for WON, whereas patients with diabetes seem to be at higher risk of developing WON.