Nomogram for prediction of adverse events after lumen-apposing metal stent placement for drainage of pancreatic fluid collections.
LAMS
complication
predictive model
pseudocyst
walled-off necrosis
Journal
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
ISSN: 1443-1661
Titre abrégé: Dig Endosc
Pays: Australia
ID NLM: 9101419
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
14
02
2022
accepted:
18
05
2022
pubmed:
24
5
2022
medline:
11
11
2022
entrez:
23
5
2022
Statut:
ppublish
Résumé
To generate a prognostic model based on a nomogram for adverse event (AE) prediction after lumen-apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC). Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Results were expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Discrimination was assessed by c-statistics and calibrated by comparing deciles of predicted and observed ORs. Overall, 516 patients were included (males 68%, mean age 61.6 ± 15.2 years). PFCs were predominantly walled-off necrosis (52.1%). Independent predictors of AE occurrence were injury of main pancreatic duct (OR in the case of leak 2.51, 95% CI 1.06-5.97, P = 0.03; OR in the case of complete disruption 2.61, 1.53-4.45, P = 0.01), abnormal vessels (OR in the case of perigastric varices 2.90, 1.31-6.42, P = 0.008; OR in the case of pseudoaneurysm 2.99, 1.75-11.93, P = 0.002), using a multigate technique (OR 3.00, 1.28-5.24; P = 0.05), and need of percutaneous drainage (OR 2.81, 1.03-7.65, P = 0.04). By nomogram, a score beyond 200 points corresponded to a 50% probability of AE occurrence. The model was confirmed even when excluding mild AEs and it showed optimal discrimination (c-index 76.8%, 95% CI 74-79), confirmed after internal validation. Patients with preprocedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage or a multigate technique are at higher risk for AE.
Substances chimiques
Metals
0
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1459-1470Investigateurs
Daryl Ramai
(D)
Edoardo Forti
(E)
Maria Chiara Petrone
(MC)
Roberto Di Mitri
(R)
Debora Berretti
(D)
Germana De Nucci
(G)
Raffaele Macchiarelli
(R)
Mauro Lovera
(M)
Fabia Attili
(F)
Mario Luciano Brancaccio
(ML)
Alessandro Redaelli
(A)
Enrico Tasini
(E)
Marco Ballarè
(M)
Franco Coppola
(F)
Nicola Leone
(N)
Luigi Cugia
(L)
Roberto Grassia
(R)
Monica Sbrancia
(M)
Thomas Togliani
(T)
Pietro Fusaroli
(P)
Claudio De Angelis
(C)
Fabio Cipolletta
(F)
Mauro Manno
(M)
Roberta Badas
(R)
Valeria Pollino
(V)
Lorenzo Camellini
(L)
Laura Bernardoni
(L)
Elisabetta Conte
(E)
Andrea Lisotti
(A)
Massimiliano Mutignani
(M)
Paolo Giorgio Arcidiacono
(PG)
Informations de copyright
© 2022 Japan Gastroenterological Endoscopy Society.
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