730 MANAGEMENT OF WALLED OFF PANCREATIC NECROSIS WITH NASOCYSTIC IRRIGATION VERSUS LUMEN APPOSING METAL STENT (LAMS) - RANDOMIZED CONTROLLED TRIAL

Abstract

Walled off pancreatic necrosis (WON) is an important complication of acute necrotizing pancreatitis (ANP). There are limited data on comparison of nasocystic irrigation versus lumen apposing metal stent (LAMS) in management of WON. We compare the technical and clinical success of both the treatment strategies. A randomized controlled trial conducted on patients with ANP with symptomatic WON who were randomized to nasocystic irrigation with hydrogen peroxide (group A) and LAMS placement (group B). ANP was diagnosed based on clinical features, laboratory parameters and imaging. Primary end points were clinical and technical success of both the procedures. 47 patients were randomized till date to group A (n=24, age 37.8±27.4 years, 15 men) and group B (n=23, age 40.9±20.6 years, 17 men). There were no significant difference in baseline characteristics between the two groups. Most common etiology was alcohol observed in 27(57.4%) patients and most common symptom was abdominal pain seen in all patients. Technical success (100% vs 91.4%, p=0.95) and clinical success (83.33% vs 78.3%, p =0.9), additional procedures to get clinical success (15% vs 21.66%, p=0.9) and complications (4 vs 5, p=0.9) were comparable in both the groups. The duration to get clinical success (35.5±49.1 days vs 14.9 ±24.8 days, p =0.004) was longer in group A compared to group B. LAMS and nasocystic irrigation with H2O2 are equally effective in the treatment of WON but duration of clinical success is longer with nasocystic irrigation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)