Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy
Background Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (E...
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| Veröffentlicht in: | Journal of hepato-biliary-pancreatic sciences 2017-12, Vol.24 (12), p.649-656 |
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| creator | Kuwahara, Takamichi Hirooka, Yoshiki Kawashima, Hiroki Ohno, Eizaburo Yokoyama, Yukihiro Fujii, Tsutomu Nakamura, Shigeo Kodera, Yasuhiro Nagino, Masato Goto, Hidemi |
| description | Background
Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (EUS‐EG), which objectively assesses tissue elasticity, predict the development of PF following PD.
Methods
Fifty‐nine patients who underwent EUS‐EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated.
Results
Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut‐off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008).
Conclusions
Endoscopic ultrasonography‐elastography may be an accurate and objective method for predicting PF following PD.
Highlight
Kuwahara and colleagues evaluated the efficacy of endoscopic ultrasonography‐guided elastography, which allows objective assessment of tissue elasticity, in predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. The mean elasticity of the body of the pancreas calculated using histogram analysis was found to correlate with the postoperative incidence of pancreatic fistula. |
| doi_str_mv | 10.1002/jhbp.514 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1951569747</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1972243123</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4394-19976d7fe963cf479f20b02aefe321310215e42b6fcf20dd85da133c33b48ab23</originalsourceid><addsrcrecordid>eNp1kdtKHTEUhoNUVKzgE5RAb3ozmsOccmnFQ0VoL-r1kElW3LPJnkxzUPadj6Cv6JM0g7tbKJibJPwfH4v1I3RMyQklhJ0uF_10UtFyBx3Qtm6LWrTs0_bdlPvoKIQlyYdTLjjZQ_tMEM5qIg7Qy10Ak-wIIWBnMIzaBeWmQeFko5fBje7ey2mxfn16BitD3HyxDFjiyYMeVBweAEfnLDbO47gA7JRK3sOoYJZOclQeZMxSM4SYrMTSRPDbwOnkNIygolutP6NdI22Ao819iO4uL36fXxe3P69-nJ_dFqrkoiyoEE2tGwOi5sqUjTCM9IRJMMAZ5ZQwWkHJ-tqonGjdVlpSzhXnfdnKnvFD9O3NO3n3J0GI3WoICqyVI7gUOioqWs37azL69T906ZIf83SZahgrOWX8Xai8C8GD6SY_rKRfd5R0c1Pd3FSXm8rol40w9SvQW_BfLxko3oDHwcL6Q1F3c_391yz8C1btoV8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1972243123</pqid></control><display><type>article</type><title>Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy</title><source>MEDLINE</source><source>Wiley Blackwell Single Titles</source><creator>Kuwahara, Takamichi ; Hirooka, Yoshiki ; Kawashima, Hiroki ; Ohno, Eizaburo ; Yokoyama, Yukihiro ; Fujii, Tsutomu ; Nakamura, Shigeo ; Kodera, Yasuhiro ; Nagino, Masato ; Goto, Hidemi</creator><creatorcontrib>Kuwahara, Takamichi ; Hirooka, Yoshiki ; Kawashima, Hiroki ; Ohno, Eizaburo ; Yokoyama, Yukihiro ; Fujii, Tsutomu ; Nakamura, Shigeo ; Kodera, Yasuhiro ; Nagino, Masato ; Goto, Hidemi</creatorcontrib><description>Background
Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (EUS‐EG), which objectively assesses tissue elasticity, predict the development of PF following PD.
Methods
Fifty‐nine patients who underwent EUS‐EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated.
Results
Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut‐off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008).
Conclusions
Endoscopic ultrasonography‐elastography may be an accurate and objective method for predicting PF following PD.
Highlight
Kuwahara and colleagues evaluated the efficacy of endoscopic ultrasonography‐guided elastography, which allows objective assessment of tissue elasticity, in predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. The mean elasticity of the body of the pancreas calculated using histogram analysis was found to correlate with the postoperative incidence of pancreatic fistula.</description><identifier>ISSN: 1868-6974</identifier><identifier>EISSN: 1868-6982</identifier><identifier>DOI: 10.1002/jhbp.514</identifier><identifier>PMID: 29032609</identifier><language>eng</language><publisher>Japan: Wiley Subscription Services, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Elasticity Imaging Techniques - methods ; Elastography ; Endoscopic ultrasonography ; Endoscopy ; Endosonography - methods ; Female ; Fistula ; Follow-Up Studies ; Humans ; Incidence ; Japan - epidemiology ; Male ; Middle Aged ; Pancreas - diagnostic imaging ; Pancreas - surgery ; Pancreatic Diseases - surgery ; Pancreatic fistula ; Pancreatic Fistula - diagnosis ; Pancreatic Fistula - epidemiology ; Pancreatic Fistula - etiology ; Pancreaticoduodenectomy ; Pancreaticoduodenectomy - adverse effects ; Pancreatoduodenectomy ; Postoperative Complications ; Reproducibility of Results ; Retrospective Studies ; Ultrasonic imaging ; Young Adult</subject><ispartof>Journal of hepato-biliary-pancreatic sciences, 2017-12, Vol.24 (12), p.649-656</ispartof><rights>2017 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery</rights><rights>2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.</rights><rights>Copyright © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4394-19976d7fe963cf479f20b02aefe321310215e42b6fcf20dd85da133c33b48ab23</citedby><cites>FETCH-LOGICAL-c4394-19976d7fe963cf479f20b02aefe321310215e42b6fcf20dd85da133c33b48ab23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjhbp.514$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjhbp.514$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29032609$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kuwahara, Takamichi</creatorcontrib><creatorcontrib>Hirooka, Yoshiki</creatorcontrib><creatorcontrib>Kawashima, Hiroki</creatorcontrib><creatorcontrib>Ohno, Eizaburo</creatorcontrib><creatorcontrib>Yokoyama, Yukihiro</creatorcontrib><creatorcontrib>Fujii, Tsutomu</creatorcontrib><creatorcontrib>Nakamura, Shigeo</creatorcontrib><creatorcontrib>Kodera, Yasuhiro</creatorcontrib><creatorcontrib>Nagino, Masato</creatorcontrib><creatorcontrib>Goto, Hidemi</creatorcontrib><title>Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy</title><title>Journal of hepato-biliary-pancreatic sciences</title><addtitle>J Hepatobiliary Pancreat Sci</addtitle><description>Background
Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (EUS‐EG), which objectively assesses tissue elasticity, predict the development of PF following PD.
Methods
Fifty‐nine patients who underwent EUS‐EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated.
Results
Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut‐off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008).
Conclusions
Endoscopic ultrasonography‐elastography may be an accurate and objective method for predicting PF following PD.
Highlight
Kuwahara and colleagues evaluated the efficacy of endoscopic ultrasonography‐guided elastography, which allows objective assessment of tissue elasticity, in predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. The mean elasticity of the body of the pancreas calculated using histogram analysis was found to correlate with the postoperative incidence of pancreatic fistula.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>Elastography</subject><subject>Endoscopic ultrasonography</subject><subject>Endoscopy</subject><subject>Endosonography - methods</subject><subject>Female</subject><subject>Fistula</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreas - diagnostic imaging</subject><subject>Pancreas - surgery</subject><subject>Pancreatic Diseases - surgery</subject><subject>Pancreatic fistula</subject><subject>Pancreatic Fistula - diagnosis</subject><subject>Pancreatic Fistula - epidemiology</subject><subject>Pancreatic Fistula - etiology</subject><subject>Pancreaticoduodenectomy</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreatoduodenectomy</subject><subject>Postoperative Complications</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Ultrasonic imaging</subject><subject>Young Adult</subject><issn>1868-6974</issn><issn>1868-6982</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdtKHTEUhoNUVKzgE5RAb3ozmsOccmnFQ0VoL-r1kElW3LPJnkxzUPadj6Cv6JM0g7tbKJibJPwfH4v1I3RMyQklhJ0uF_10UtFyBx3Qtm6LWrTs0_bdlPvoKIQlyYdTLjjZQ_tMEM5qIg7Qy10Ak-wIIWBnMIzaBeWmQeFko5fBje7ey2mxfn16BitD3HyxDFjiyYMeVBweAEfnLDbO47gA7JRK3sOoYJZOclQeZMxSM4SYrMTSRPDbwOnkNIygolutP6NdI22Ao819iO4uL36fXxe3P69-nJ_dFqrkoiyoEE2tGwOi5sqUjTCM9IRJMMAZ5ZQwWkHJ-tqonGjdVlpSzhXnfdnKnvFD9O3NO3n3J0GI3WoICqyVI7gUOioqWs37azL69T906ZIf83SZahgrOWX8Xai8C8GD6SY_rKRfd5R0c1Pd3FSXm8rol40w9SvQW_BfLxko3oDHwcL6Q1F3c_391yz8C1btoV8</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Kuwahara, Takamichi</creator><creator>Hirooka, Yoshiki</creator><creator>Kawashima, Hiroki</creator><creator>Ohno, Eizaburo</creator><creator>Yokoyama, Yukihiro</creator><creator>Fujii, Tsutomu</creator><creator>Nakamura, Shigeo</creator><creator>Kodera, Yasuhiro</creator><creator>Nagino, Masato</creator><creator>Goto, Hidemi</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201712</creationdate><title>Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy</title><author>Kuwahara, Takamichi ; Hirooka, Yoshiki ; Kawashima, Hiroki ; Ohno, Eizaburo ; Yokoyama, Yukihiro ; Fujii, Tsutomu ; Nakamura, Shigeo ; Kodera, Yasuhiro ; Nagino, Masato ; Goto, Hidemi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4394-19976d7fe963cf479f20b02aefe321310215e42b6fcf20dd85da133c33b48ab23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>Elastography</topic><topic>Endoscopic ultrasonography</topic><topic>Endoscopy</topic><topic>Endosonography - methods</topic><topic>Female</topic><topic>Fistula</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Japan - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreas - diagnostic imaging</topic><topic>Pancreas - surgery</topic><topic>Pancreatic Diseases - surgery</topic><topic>Pancreatic fistula</topic><topic>Pancreatic Fistula - diagnosis</topic><topic>Pancreatic Fistula - epidemiology</topic><topic>Pancreatic Fistula - etiology</topic><topic>Pancreaticoduodenectomy</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreatoduodenectomy</topic><topic>Postoperative Complications</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Ultrasonic imaging</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kuwahara, Takamichi</creatorcontrib><creatorcontrib>Hirooka, Yoshiki</creatorcontrib><creatorcontrib>Kawashima, Hiroki</creatorcontrib><creatorcontrib>Ohno, Eizaburo</creatorcontrib><creatorcontrib>Yokoyama, Yukihiro</creatorcontrib><creatorcontrib>Fujii, Tsutomu</creatorcontrib><creatorcontrib>Nakamura, Shigeo</creatorcontrib><creatorcontrib>Kodera, Yasuhiro</creatorcontrib><creatorcontrib>Nagino, Masato</creatorcontrib><creatorcontrib>Goto, Hidemi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepato-biliary-pancreatic sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kuwahara, Takamichi</au><au>Hirooka, Yoshiki</au><au>Kawashima, Hiroki</au><au>Ohno, Eizaburo</au><au>Yokoyama, Yukihiro</au><au>Fujii, Tsutomu</au><au>Nakamura, Shigeo</au><au>Kodera, Yasuhiro</au><au>Nagino, Masato</au><au>Goto, Hidemi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy</atitle><jtitle>Journal of hepato-biliary-pancreatic sciences</jtitle><addtitle>J Hepatobiliary Pancreat Sci</addtitle><date>2017-12</date><risdate>2017</risdate><volume>24</volume><issue>12</issue><spage>649</spage><epage>656</epage><pages>649-656</pages><issn>1868-6974</issn><eissn>1868-6982</eissn><abstract>Background
Pancreatic fistula (PF) is a major complication following pancreatoduodenectomy (PD). Pancreatic texture is a risk factor for PF, but its evaluation depends on the subjective judgment. The aim of this study was to investigate whether preoperative endoscopic ultrasonography‐elastography (EUS‐EG), which objectively assesses tissue elasticity, predict the development of PF following PD.
Methods
Fifty‐nine patients who underwent EUS‐EG before PD and had pancreas parenchyma histologically evaluated were included. Using histogram analysis, mean elasticity (ME), which represents tissue elasticity and is inversely correlated with pancreatic fibrosis, was calculated.
Results
Among 59 patients, 19 developed PF (32.2%). The ME in patients with PF was significantly higher than that in patients without PF (85.4 vs. 55.6, P < 0.001). Area under the receiver operating characteristic curve for the accuracy of pancreatic texture and ME for predicting PF were 0.718 and 0.846, respectively. When a ME of 70.0 was used as a cut‐off value for predicting PF, the sensitivity and specificity were 84.2% and 80.0%, respectively. In a multivariate logistic regression analysis, only a ME of >70.0 was an independent predictor of PF (odds ratio 10.02, P = 0.008).
Conclusions
Endoscopic ultrasonography‐elastography may be an accurate and objective method for predicting PF following PD.
Highlight
Kuwahara and colleagues evaluated the efficacy of endoscopic ultrasonography‐guided elastography, which allows objective assessment of tissue elasticity, in predicting the occurrence of pancreatic fistula after pancreatoduodenectomy. The mean elasticity of the body of the pancreas calculated using histogram analysis was found to correlate with the postoperative incidence of pancreatic fistula.</abstract><cop>Japan</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29032609</pmid><doi>10.1002/jhbp.514</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Elasticity Imaging Techniques - methods Elastography Endoscopic ultrasonography Endoscopy Endosonography - methods Female Fistula Follow-Up Studies Humans Incidence Japan - epidemiology Male Middle Aged Pancreas - diagnostic imaging Pancreas - surgery Pancreatic Diseases - surgery Pancreatic fistula Pancreatic Fistula - diagnosis Pancreatic Fistula - epidemiology Pancreatic Fistula - etiology Pancreaticoduodenectomy Pancreaticoduodenectomy - adverse effects Pancreatoduodenectomy Postoperative Complications Reproducibility of Results Retrospective Studies Ultrasonic imaging Young Adult |
| title | Usefulness of endoscopic ultrasonography‐elastography as a predictive tool for the occurrence of pancreatic fistula after pancreatoduodenectomy |
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