Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Multicenter study with nationwide data-based validation

Tsuyoshi Hamada; Atsuhiro Masuda; Nobuaki Michihata; Tomotaka Saito; Masahiro Tsujimae; Mamoru Takenaka; Shunsuke Omoto; Takuji Iwashita; Shinya Uemura; Shogo Ota; Hideyuki Shiomi; Toshio Fujisawa; Sho Takahashi; Saburo Matsubara; Kentaro Suda; Hiroki Matsui; Akinori Maruta; Kensaku Yoshida; Keisuke Iwata; Mitsuru Okuno; Nobuhiko Hayashi; Tsuyoshi Mukai; Kiyohide Fushimi; Ichiro Yasuda; Hiroyuki Isayama; Hideo Yasunaga; Yousuke Nakai; WONDERFUL study group in Japan and collaborators

doi:10.1111/den.14924

Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Multicenter study with nationwide data-based validation

Dig Endosc. 2024 Sep 26. doi: 10.1111/den.14924. Online ahead of print.

Authors

Tsuyoshi Hamada^{1

2}, Atsuhiro Masuda³, Nobuaki Michihata⁴, Tomotaka Saito¹, Masahiro Tsujimae³, Mamoru Takenaka⁵, Shunsuke Omoto⁵, Takuji Iwashita⁶, Shinya Uemura⁶, Shogo Ota^{3

7}, Hideyuki Shiomi⁷, Toshio Fujisawa⁸, Sho Takahashi⁸, Saburo Matsubara⁹, Kentaro Suda⁹, Hiroki Matsui¹⁰, Akinori Maruta¹¹, Kensaku Yoshida¹¹, Keisuke Iwata¹², Mitsuru Okuno¹², Nobuhiko Hayashi¹³, Tsuyoshi Mukai¹⁴, Kiyohide Fushimi¹⁵, Ichiro Yasuda¹³, Hiroyuki Isayama⁸, Hideo Yasunaga¹⁰, Yousuke Nakai^{1

16}; WONDERFUL study group in Japan and collaborators

Collaborators

WONDERFUL study group in Japan and collaborators:
Tatsuya Sato, Arata Sakai, Ryota Nakano, Keito Nakagawa, Yuhei Iwasa

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
³ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
⁴ Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan.
⁶ First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
⁷ Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan.
⁸ Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
⁹ Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
¹⁰ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
¹¹ Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.
¹² Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
¹³ Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
¹⁴ Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan.
¹⁵ Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁶ Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan.

PMID: 39325002
DOI: 10.1111/den.14924

Abstract

Objectives: The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment.

Methods: Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020.

Results: In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (P_trend < 0.001). Compared to patients with CCI = 0, patients with CCI of 1-2, 3-5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (P_trend < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (P_trend < 0.001), but not in the clinical cohort (P_trend = 0.18). CCI was not associated with the risk of procedure-related adverse events.

Conclusions: Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk.

Trial registration: The research based on the clinical data from the WONDERFULcohort was registered with UMIN-CTR (registration number UMIN000044130).

Keywords: acute necrotizing pancreatitis; cohort study; endosonography; risk factor; stent.

Abstract

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