PREDICTORS OF ADVERSE EVENTS AFTER ENDOSCOPIC ULTRASOUND THROUGH-THE-NEEDLE BIOPSY OF PANCREATIC CYSTS: A RECURSIVE PARTITIONING ANALYSIS.
Por:
Facciorusso A, Kovacevic B, Yang D, Vilas-Boas F, Martínez B, Stigliano S, Rizzatti G, Sacco M, Arevalo-Mora M, Villarreal-Sanchez L, Conti Bellocchi MC, Bernardoni L, Gabbrielli A, Barresi L, Gkolfakis P, Robles-Medranda C, De Angelis C, Larghi A, Di Matteo F, Aparicio JR, Macedo G, Draganov PV, Vilmann P, Pecchia L, Repici A and Crinó SF
Publicada:
1 dic 2022
Ahead of Print:
21 abr 2022
Resumen:
Background and study aims Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA). Patients and methods Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. Results Mean cysts size was 36.7mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45%), serous cystadenoma (18.8%), and mucinous cystadenoma (12.8%). Fifty-eight (11.5%) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p=0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p=0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p<0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28% AEs rate), low-risk (1.4% AE rate, including patients <64 years with other-than-IPMN diagnosis sampled with =2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1% AEs rate, including the remaining patients). Conclusion TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.
Filiaciones:
Facciorusso A:
Medical Sciences, University of Foggia, Foggia, Italy
Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
Kovacevic B:
Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
Yang D:
Center of Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
Vilas-Boas F:
Gastroenterogy department, Hospital de São João, Porto, Portugal
:
Servicio de Aparato Digestivo, Hospital Universitario del Vinalopo, Elche, Spain
Stigliano S:
Operative Endoscopy Department, Campus Bio-Medico University, Roma, Italy
Rizzatti G:
Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Sacco M:
Gastroenterology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
Arevalo-Mora M:
Instituto Ecuatoriano de Enfermedades Digestivas, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
Villarreal-Sanchez L:
Digestive Diseases Center, Gastrocare, Quito, Ecuador
Conti Bellocchi MC:
Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
Bernardoni L:
Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
Gabbrielli A:
Department of medicine, Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
Barresi L:
gastroenterology, IsMeTT/UPMC, Palermo, Italy
Gkolfakis P:
Gastroenterology, Erasme University Hospital, Brussels, Belgium
Robles-Medranda C:
Endoscopy, Omni Hospital, Guayaquil, Ecuador
Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
De Angelis C:
Department of Gastrohepatology, University of Turin, Turin, Italy
Larghi A:
Digestive Endoscopy Unit, Universita' Cattolica del Sacro Cuore, Rome, Italy
Di Matteo F:
Digestive Diseases, GI Endoscopy Unit, Campus Bio-Medico University, Rome, Italy
:
Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. ISABIAL., Hospital General Universitario de Alicante, Alicante, Spain
Macedo G:
Gastroenterology, Centro Hospitalar de Sao Joao, Porto, Portugal
Draganov PV:
Medicine/Gastroenterology, University of Florida, Gainesville, United States
Vilmann P:
Herlev and Gentofte Hospital, University of Copenhagen, Department of Surgical Gastroenterology, Herlev, Denmark
Pecchia L:
School of Engineering, University of Warwick, Coventry, United Kingdom of Great Britain and Northern Ireland
Repici A:
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
Crinó SF:
Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy
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