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.

中文翻译：

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基于计算机断层扫描成像的预测因素，预测在初始内窥镜超声引导的胰液收集透壁引流后需要升级方法。

背景技术推荐将升压法作为胰液积聚 (PFC) 的新治疗算法。然而，尚不清楚哪些 PFC 患者在超声内镜引导透壁引流 (EUS-TD) 后需要升压治疗。如果可以预测需要升压治疗，则可以及早对相关患者进行治疗。我们的目的是确定 EUS-TD 后升压方法的 PFC 相关预测因素。方法 这项回顾性队列研究包括从 2008 年 1 月到 2020 年 5 月连续接受 EUS-TD 治疗 PFC 的患者。进行多变量逻辑回归分析以调查与需要升压治疗相关的 PFC 因素。对临床上对 EUS-TD 无反应的患者进行升阶治疗。结果 我们纳入了 81 名患者，其中 25 名 (30. 9%) 需要升级方法。在多变量逻辑回归分析中，EUS-TD 前 PFC 占据区域数≥ 3（多变量比值比 [OR] 16.2，95% 置信区间 [CI] 2.68-97.6，P = 0.002），EUS 后 - TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91-136.1, P = 0.002), 阳性海绵体征, 是EUS-TD后早期CT显着表现 (multivariate OR 6.26 , 95% CI 1.33-29.3, P = 0.020), 是与需要 PFC 升压方法相关的独立预测因素。结论 EUS-TD 前 PFC 占据区域、EUS-TD 后 PFC 剩余百分比和阳性海绵征是需要升级方法的预测指标。应为具有这些发现的 PFC 患者提供升阶梯治疗，而对于没有这些发现的患者，建议采用保守治疗。临床注册号 UMIN 000030898。