Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections
Background A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach c...
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| Veröffentlicht in: | Surgical endoscopy 2023-02, Vol.37 (2), p.1096-1106 |
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| creator | Tsujimae, Masahiro Shiomi, Hideyuki Sakai, Arata Masuda, Atsuhiro Inomata, Noriko Kohashi, Shinya Nagao, Kae Uemura, Hisahiro Masuda, Shigeto Gonda, Masanori Abe, Shohei Ashina, Shigeto Yamakawa, Kohei Tanaka, Takeshi Nakano, Ryota Kobayashi, Takashi Kodama, Yuzo |
| description | Background
A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD.
Methods
This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD.
Results
We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68–97.6,
P
= 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91–136.1,
P
= 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33–29.3,
P
= 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs.
Conclusion
Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings.
Clinical registration number
UMIN 000030898. |
| doi_str_mv | 10.1007/s00464-022-09610-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2716088345</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2716088345</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-f274dfb19a9cc4058567d99ea4a7242e62203efb8fca4fc7ebf432ee57b0d40d3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhiMEoqeFF2CBLLFhY_AtcbJER1wqVWID68ixxzmuEtv4suhT8Yq4PQUkFqwszXz_P-P5u-4VJe8oIfJ9JkQMAhPGMJkGSjB70h2o4AwzRsen3YFMvBXlJC66y5xvSeMn2j_vLvhAGe-FPHQ_j2GPtYBBJexhTSqe7pDb1er8iheVWyMmME6XkDIKFpUTIA-tbENCCuUCEdeIVIwpKH1CyhZIyHlXnNoQeBOyDtFpVLeSVA7VG7xWZ-4nJuXzXlPjTFLOqxUeXKPyOoEqTWS3hiIdtg10ccHnF90zq7YMLx_fq-77p4_fjl_wzdfP18cPN1hz2RdsmRTGLnRSk9aC9GM_SDNNoISSTDAYGCMc7DJarYTVEhbb7gbQy4UYQQy_6t6efdu3flTIZd5d1rBtykOoeWaSDmQcuegb-uYf9DbU5Nt2jZKjaPfnY6PYmdIp5JzAzjG1O6e7mZL5Ps75HOfc4pwf4pxZE71-tK7LDuaP5Hd-DeBnILeWXyH9nf0f21_Lla-2</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2778479438</pqid></control><display><type>article</type><title>Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Tsujimae, Masahiro ; Shiomi, Hideyuki ; Sakai, Arata ; Masuda, Atsuhiro ; Inomata, Noriko ; Kohashi, Shinya ; Nagao, Kae ; Uemura, Hisahiro ; Masuda, Shigeto ; Gonda, Masanori ; Abe, Shohei ; Ashina, Shigeto ; Yamakawa, Kohei ; Tanaka, Takeshi ; Nakano, Ryota ; Kobayashi, Takashi ; Kodama, Yuzo</creator><creatorcontrib>Tsujimae, Masahiro ; Shiomi, Hideyuki ; Sakai, Arata ; Masuda, Atsuhiro ; Inomata, Noriko ; Kohashi, Shinya ; Nagao, Kae ; Uemura, Hisahiro ; Masuda, Shigeto ; Gonda, Masanori ; Abe, Shohei ; Ashina, Shigeto ; Yamakawa, Kohei ; Tanaka, Takeshi ; Nakano, Ryota ; Kobayashi, Takashi ; Kodama, Yuzo</creatorcontrib><description>Background
A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD.
Methods
This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD.
Results
We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68–97.6,
P
= 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91–136.1,
P
= 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33–29.3,
P
= 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs.
Conclusion
Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings.
Clinical registration number
UMIN 000030898.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-022-09610-2</identifier><identifier>PMID: 36123547</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Drainage - methods ; Endoscopy ; Endosonography - methods ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Original Article ; Pancreas ; Pancreatic Diseases ; Proctology ; Regression analysis ; Retrospective Studies ; Stents ; Surgery ; Tomography ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonography, Interventional - methods ; UMIN ; UMIN000030898</subject><ispartof>Surgical endoscopy, 2023-02, Vol.37 (2), p.1096-1106</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-f274dfb19a9cc4058567d99ea4a7242e62203efb8fca4fc7ebf432ee57b0d40d3</citedby><cites>FETCH-LOGICAL-c375t-f274dfb19a9cc4058567d99ea4a7242e62203efb8fca4fc7ebf432ee57b0d40d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-022-09610-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-022-09610-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36123547$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsujimae, Masahiro</creatorcontrib><creatorcontrib>Shiomi, Hideyuki</creatorcontrib><creatorcontrib>Sakai, Arata</creatorcontrib><creatorcontrib>Masuda, Atsuhiro</creatorcontrib><creatorcontrib>Inomata, Noriko</creatorcontrib><creatorcontrib>Kohashi, Shinya</creatorcontrib><creatorcontrib>Nagao, Kae</creatorcontrib><creatorcontrib>Uemura, Hisahiro</creatorcontrib><creatorcontrib>Masuda, Shigeto</creatorcontrib><creatorcontrib>Gonda, Masanori</creatorcontrib><creatorcontrib>Abe, Shohei</creatorcontrib><creatorcontrib>Ashina, Shigeto</creatorcontrib><creatorcontrib>Yamakawa, Kohei</creatorcontrib><creatorcontrib>Tanaka, Takeshi</creatorcontrib><creatorcontrib>Nakano, Ryota</creatorcontrib><creatorcontrib>Kobayashi, Takashi</creatorcontrib><creatorcontrib>Kodama, Yuzo</creatorcontrib><title>Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD.
Methods
This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD.
Results
We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68–97.6,
P
= 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91–136.1,
P
= 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33–29.3,
P
= 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs.
Conclusion
Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings.
Clinical registration number
UMIN 000030898.</description><subject>Abdominal Surgery</subject><subject>Drainage - methods</subject><subject>Endoscopy</subject><subject>Endosonography - methods</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Pancreas</subject><subject>Pancreatic Diseases</subject><subject>Proctology</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Surgery</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Interventional - methods</subject><subject>UMIN</subject><subject>UMIN000030898</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhiMEoqeFF2CBLLFhY_AtcbJER1wqVWID68ixxzmuEtv4suhT8Yq4PQUkFqwszXz_P-P5u-4VJe8oIfJ9JkQMAhPGMJkGSjB70h2o4AwzRsen3YFMvBXlJC66y5xvSeMn2j_vLvhAGe-FPHQ_j2GPtYBBJexhTSqe7pDb1er8iheVWyMmME6XkDIKFpUTIA-tbENCCuUCEdeIVIwpKH1CyhZIyHlXnNoQeBOyDtFpVLeSVA7VG7xWZ-4nJuXzXlPjTFLOqxUeXKPyOoEqTWS3hiIdtg10ccHnF90zq7YMLx_fq-77p4_fjl_wzdfP18cPN1hz2RdsmRTGLnRSk9aC9GM_SDNNoISSTDAYGCMc7DJarYTVEhbb7gbQy4UYQQy_6t6efdu3flTIZd5d1rBtykOoeWaSDmQcuegb-uYf9DbU5Nt2jZKjaPfnY6PYmdIp5JzAzjG1O6e7mZL5Ps75HOfc4pwf4pxZE71-tK7LDuaP5Hd-DeBnILeWXyH9nf0f21_Lla-2</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Tsujimae, Masahiro</creator><creator>Shiomi, Hideyuki</creator><creator>Sakai, Arata</creator><creator>Masuda, Atsuhiro</creator><creator>Inomata, Noriko</creator><creator>Kohashi, Shinya</creator><creator>Nagao, Kae</creator><creator>Uemura, Hisahiro</creator><creator>Masuda, Shigeto</creator><creator>Gonda, Masanori</creator><creator>Abe, Shohei</creator><creator>Ashina, Shigeto</creator><creator>Yamakawa, Kohei</creator><creator>Tanaka, Takeshi</creator><creator>Nakano, Ryota</creator><creator>Kobayashi, Takashi</creator><creator>Kodama, Yuzo</creator><general>Springer US</general><general>Springer Nature B.V</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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20230201</creationdate><title>Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections</title><author>Tsujimae, Masahiro ; Shiomi, Hideyuki ; Sakai, Arata ; Masuda, Atsuhiro ; Inomata, Noriko ; Kohashi, Shinya ; Nagao, Kae ; Uemura, Hisahiro ; Masuda, Shigeto ; Gonda, Masanori ; Abe, Shohei ; Ashina, Shigeto ; Yamakawa, Kohei ; Tanaka, Takeshi ; Nakano, Ryota ; Kobayashi, Takashi ; Kodama, Yuzo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-f274dfb19a9cc4058567d99ea4a7242e62203efb8fca4fc7ebf432ee57b0d40d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Drainage - methods</topic><topic>Endoscopy</topic><topic>Endosonography - methods</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Pancreas</topic><topic>Pancreatic Diseases</topic><topic>Proctology</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Surgery</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Interventional - methods</topic><topic>UMIN</topic><topic>UMIN000030898</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsujimae, Masahiro</creatorcontrib><creatorcontrib>Shiomi, Hideyuki</creatorcontrib><creatorcontrib>Sakai, Arata</creatorcontrib><creatorcontrib>Masuda, Atsuhiro</creatorcontrib><creatorcontrib>Inomata, Noriko</creatorcontrib><creatorcontrib>Kohashi, Shinya</creatorcontrib><creatorcontrib>Nagao, Kae</creatorcontrib><creatorcontrib>Uemura, Hisahiro</creatorcontrib><creatorcontrib>Masuda, Shigeto</creatorcontrib><creatorcontrib>Gonda, Masanori</creatorcontrib><creatorcontrib>Abe, Shohei</creatorcontrib><creatorcontrib>Ashina, Shigeto</creatorcontrib><creatorcontrib>Yamakawa, Kohei</creatorcontrib><creatorcontrib>Tanaka, Takeshi</creatorcontrib><creatorcontrib>Nakano, Ryota</creatorcontrib><creatorcontrib>Kobayashi, Takashi</creatorcontrib><creatorcontrib>Kodama, Yuzo</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 Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsujimae, Masahiro</au><au>Shiomi, Hideyuki</au><au>Sakai, Arata</au><au>Masuda, Atsuhiro</au><au>Inomata, Noriko</au><au>Kohashi, Shinya</au><au>Nagao, Kae</au><au>Uemura, Hisahiro</au><au>Masuda, Shigeto</au><au>Gonda, Masanori</au><au>Abe, Shohei</au><au>Ashina, Shigeto</au><au>Yamakawa, Kohei</au><au>Tanaka, Takeshi</au><au>Nakano, Ryota</au><au>Kobayashi, Takashi</au><au>Kodama, Yuzo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>37</volume><issue>2</issue><spage>1096</spage><epage>1106</epage><pages>1096-1106</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD.
Methods
This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD.
Results
We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68–97.6,
P
= 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91–136.1,
P
= 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33–29.3,
P
= 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs.
Conclusion
Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings.
Clinical registration number
UMIN 000030898.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36123547</pmid><doi>10.1007/s00464-022-09610-2</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2023-02, Vol.37 (2), p.1096-1106 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Drainage - methods Endoscopy Endosonography - methods Gastroenterology Gynecology Hepatology Humans Medicine Medicine & Public Health Original Article Pancreas Pancreatic Diseases Proctology Regression analysis Retrospective Studies Stents Surgery Tomography Tomography, X-Ray Computed Treatment Outcome Ultrasonic imaging Ultrasonography, Interventional - methods UMIN UMIN000030898 |
| title | Computed tomography imaging-based predictors of the need for a step-up approach after initial endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections |
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