IDDF2019-ABS-0233 Long term indwelling transmural stents in patients with walled off pancreatic necrosis and disconnected pancreatic duct syndrome: safety and efficacy

Abstract

Background Long-term indwelling transmural stents in patients with walled-off pancreatic necrosis (WOPN) and disconnected pancreatic duct syndrome (DPDS) has been accepted as an effective strategy to decrease the risk of recurrence of pancreatic fluid collection (PFC). However, long term studies on the safety and efficacy of leaving permanent indwelling plastic prosthesis are lacking. Methods Retrospective analysis of the database of patients with WOPN treated with endoscopic transmural drainage over the last 8 years was done to identify patients with DPDS and permanently intended indwelling transmural stents. Patients with indwelling stents for more than 3 years were only included in this study. The follow-up database was analysed for any recurrence of symptoms or PFC or complications. Results During the last 8 years, 179 patients of WOPN were treated with endoscopic transmural drainage and 138 (77.09%) patients had DPDS. Of 138 patients, 56 patients (39 males; age range: 21–62 years) had an indwelling transmural stent/stents for >3 years (3–8 years). Amongst plastic prosthesis, 67.85% of patients had 10 Fr stents and 32.14% of patients had 7 Fr stents. Neck (n=28; 50%) was the most common site of disruption followed by proximal body (n=16; 28.57%) and distal body (n= 12; 21.43%). One patient (1.78%) developed recurrence of fluid collection 58 months later despite of in-situ stent which was successfully treated with repeat endoscopic transmural drainage. Two (3.5%) patients had asymptomatic spontaneous external migration of the transmural stent. Two (3.5%) patients developed complications 4 years later because of the indwelling stent. The transmural stent eroded into descending colon in one patient and the other patient had a recurrence of abdominal pain due to the development of pancreatic parenchymal calcification around the pigtail of the plastic stent. The transmural stent was removed in both patients and this led to the closure of colonic fistula as well cessation of abdominal pain. No other complication of long term indwelling transmural stents was observed. Conclusions Long term indwelling transmural stents in patients with WOPN and DPDS are safe as well as effective in preventing recurrence of PFC.