Tu1400 A COMPARATIVE STUDY EVALUATING LUMEN APPOSING METAL STENTS AND DOUBLE PIGTAIL PLASTIC STENTS FOR TREATMENT OF WALLED OFF NECROSIS

Abstract

EUS-guided direct endoscopic necrosectomy (DEN) is effective in the management of walled off necrosis (WON), and is preferable to percutaneous and surgical approaches. Lumen apposing metal stents (LAMS) are increasingly used for DEN, however there is limited data comparing LAMS to traditional double pigtail (DP) plastic stents. To compare clinical outcomes and adverse events between LAMS and DP stents in the endoscopic management of WON. A retrospective study was conducted at an academic tertiary referral center in the United States. Subjects included patients who underwent DEN for the management of symptomatic WON from 2003-2017. Demographics, procedural and technical characteristics, and relevant clinical outcomes were recorded. Adverse events were assessed. Characteristics and clinical outcomes were compared using Fisher’s exact test and Student’s t test when appropriate. A total of 112 patients underwent DEN during the study period, of which 33 patients underwent initial LAMS placement, and 79 patients underwent initial DP placement. Mean pancreatic fluid collection size was 90.2 x 60.1 mm, and 61.8% of patients had evidence of infected pancreatic necrosis. Overall, successful resolution of the WON was seen in 90.9% of LAMS and 76.0% of DP cases (p = 0.115), and both groups required similar numbers of total procedures until resolution of the fluid collection (1.5 vs 1.5 procedures, p = 0.767). Time to resolution of the fluid collection was significantly shorter among patients who underwent initial LAMS placement compared to patients who underwent initial DP placement (76.9 vs 136.8 days, p = 0.027). Procedural failure rates were significantly higher among patients who underwent initial DP placement compared to patients who underwent initial LAMS placement (24.1% vs 6.5%, p = 0.033). Among patients who underwent initial DP placement, 5 patients required percutaneous drainage, and 9 patients required surgical necrosectomy. No patients who underwent initial LAMS placement required percutaneous drainage or surgical necrosectomy. However, overall adverse event rates were higher among patients who underwent initial LAMS placement compared to patients who underwent initial DP placement (36.4% vs 7.6%, p < 0.001). Although LAMS is associated with increased adverse event rates compared to DP placement, initial LAMS placement for endoscopic management of pancreatic fluid collections results in significantly decreased time to resolution and lower rates of procedural failure.Tabled 1Table 1: Demographicsn (%)DemographicsTotal Patients112Mean Age (± SD, yrs)52.1 (± 15.9)Female Gender43 (38.4)Etiology of Fluid Collection/PancreatitisAlcohol22 (19.8)Gallstone33 (29.7)Hypertriglyceridemia8 (7.2)Medication4 (3.6)Autoimmune2 (1.8)Idiopathic21 (18.9)Post-Pancreatectomy13 (11.7)Post-ERCP7 (6.3)Post-Colonoscopy1 (0.9)Lesion CharacteristicsLong Dimension (± SD, mm)90.2 (± 46.1)Short Dimension (± SD, mm)60.1 (± 30.2)Presence of Infection68 (61.8) Open table in a new tab