Association Between the Morphological Features of Necrotizing Pancreatitis on Endoscopic Ultrasound and the Outcome of Endoscopic Transmural Step-Up Approach

Background: To investigate the association between features of necrotic collections on endoscopic ultrasound (EUS) and outcomes of the endoscopic transmural step-up approach. Methods: This was a retrospective cohort study analyzing patients with necrotic collections underwent endoscopic transmural step-up approach. According to the amount of solid necrotic debris quantified as a percentage of the total collection size, participants were divided into three groups: 50% (group 3). Results: Out of a total of 134 patients, the mean necrotic collection size was 8.5 (7.0, 10.0) cm, with 50% (group 3) solid debris present in 52, 59, and 23 patients, respectively. Patients with more solid necrotic debris needed more sessions of necrosectomy (group 1, 1 (0, 1) time vs. group 2, 1 (1, 2) time vs. group 3, 2 (2, 3) times, P<0.001), more likely experienced stent occlusion (group 1, 9.6% vs. group 2, 16.9% vs. group 3, 34.8%; P<0.05), and had a longer hospital stay (group 1, 25.5 (17.3, 44.0) days vs. group 2, 28.0 (19.0, 41.0) days vs. group 3, 40.0 (30.0, 58.0) days; P<0.05). Procalcitonin (OR, 6.14; 95% CI, 1.40-26.94; P<0.05) and any organ failure (OR, 11.51; 95% CI, 2.42-54.78; P<0.01) were independently associated with clinical failure of the endoscopic transmural step-up approach. Conclusions: More solid debris on EUS predicted more sessions of necrosectomy, stent occlusion, and hospital stay. Procalcitonin and organ failure are risk factors for clinical failure of the endoscopic transmural step-up approach.