P-P36 AXIOS™ stents in the management of pancreatic fluid collections: case series from a single healthcare trust

Abstract

Abstract Background This was a consecutive case-series of all pancreatic fluid collections (PFCs) managed with AXIOS™ stents in a 3 year period from a single healthcare trust, retrospectively analysed to determine the rate of technical success, clinical success and adverse events related to the procedure. Methods All patients in who underwent AXIOS stenting for PFCs in the Belfast Health and Social Care Trust between May 2016 and July 2019 were included, with a follow-up period of 1 year. Electronic care records (ECR) and Radiology reports were reviewed for each patient. PFCs were categorised into walled-of pancreatic necrosis (WOPN) and pseudocysts as per the revised Atlanta classification. The number of repeat procedures, endoscopic lavage +/- necrosectomy, the need for definitive surgery or any adverse events post-procedure were recorded. Results 45 patients were included in the study (21 male, 24 female). 17 patients (37.8 %) had WOPN and 28 (62.2 %) pancreatic pseudocysts. Median collection diameter on CT imaging was 12 cm (range 6.2 – 22 cm). The procedure was technically successful in 43 patients (95.6%), with stent mal-deployment in the remaining 2. Median duration for stenting was 29.5 days (Range 13 – 92). The procedure was clinically successful for 33 patients (73.3%). n = 8 (17.8%) of patients were re-admitted with sepsis following stent insertion requiring intravenous antibiotics. n = 16 (35.6%) patients required repeated endoscopic lavage +/- necrosectomy following stent blockage (n = 11 WOPN, n = 5 pseudocyst). n = 2 (4.4%) stents accidentally dislodged during lavage necessitating surgical removal. n = 4 (8.9%) patients required a second AXIOS stent within 45 days of removal, n = 2 (4.4%) required CT guided drainage and n = 8 (17.8%) ultimately required surgical intervention.The rate of adverse events post-procedure was 33.3%. Conclusions AXIOS stenting appears to be effective first-line in the “step-up” approach to managing PFCs. Despite some drawbacks, our study showed they were technically successful in 95.6% and clinically successful in 73.3% of cases, requiring no further intervention. For PFCs that do require surgery, AXIOS stenting may allow for a period of patient optimisation prior to definitive treatment.