Radiologic features predict more necrosectomies in walled-off necrosis

Several features of computed tomography (CT) imaging are significantly predictive of undergoing at least two necrosectomy sessions for patients with walled-off pancreatic necrosis (WON), suggest the results of a recent study.

“No established methods exist to predict who will require a higher number of endoscopic necrosectomy sessions for WON,” the investigators said, who then sought to identify radiologic predictors for requiring more necrosectomies.

A multicentre retrospective study of patients with WON was carried out at three tertiary care centres. The investigators evaluated WON characteristics on preintervention CT imaging to determine if they were associated with requiring more endoscopic necrosectomy sessions.

Of the 104 patients with WON included in this analysis, 70 (67.3 percent) underwent endoscopic necrosectomy, with a median of two sessions.

The following radiologic features were significantly associated with undergoing two or more necrosectomies: WON largest transverse diameters (p=0.02), largest coronal diameters (p=0.01), necrosis pattern (likelihood ratio [LR], 17.85; p<0.001), spread (LR, 11.02; p=0.01), haemorrhage (LR, 8.64; p=0.003), and presence of disconnected pancreatic duct (LR, 6.80; p=0.01).

On the other hand, patients with septations or loculations were significantly less likely to undergo two or more necrosectomy sessions (LR, 4.86; p=0.03).

“These [radiologic features] could help identify patients who will undergo a higher number of endoscopic necrosectomy sessions,” the investigators said.