Su1333 LUMEN APPOSING METAL STENT FOR TREATING PANCREATIC FLUID COLLECTIONS IN PATIENTS AT COMMUNITY HOSPITAL: A QUALITY IMPROVEMENT INITIATIVE TO COMPARE OUTCOMES WITH META-ANALYSIS BENCHMARK

Abstract

Acute pancreatitis can result in four different subtypes of fluid collections, including acute peri-pancreatic fluid collection (APFC), pseudocyst, acute necrotic collection (ANC), and walled-off necrosis (WON). Complications including symptoms due to large size and infection may occur and warrant intervention. Endoscopic ultrasound (EUS)-guided drainage with a lumen-apposing metal stent (LAMS) is now commonly performed for cases where certain parameters are met. Evidence from academic centers reveals comparable or even superior technical and clinical outcomes over traditional drainage. The primary aim of our study is to evaluate technical and clinical outcomes of EUS-guided LAMS at a community-based hospital. The Sarasota Memorial Hospital (SMH) Institutional Review Board (IRB) deemed this a quality improvement initiative, exempt from IRB review. Data was retrospectively collected from the SMH electronic medical records of 31 patients who underwent EUS-guided LAMS between April 2016 to October 2018. Contrast benchmarks were derived from a meta-analysis of eleven studies that evaluated efficacy of LAMS in the management in 688 patients. EUS-guided LAMS was performed by two endoscopists in 24 males and 7 females with median age of 55 years. Technical success was defined as correct placement of the stent with immediate drainage and occurred in 29 cases. Technical failure occurred in 2 cases, one due to solid debris preventing deployment of stent, and the other due to numerous varices surrounding the PFC resulting in limited access. Clinical success was defined as decrease of symptoms as well as decrease in size of the PFC and occurred in 25 cases. Four cases were considered a clinical failure: 3 patients required surgery, and one patient died due to complications from pancreatitis. Overall complications of LAMS placement included one pneumothorax, one infected WON in previously sterile WON, and one stent migration. EUS-guided LAMS for the treatment of pseudocyst or WON performed in a community hospital setting has equivalent technical and clinical outcomes and rate of complications compared to benchmarks established in an academic medical center.