Infected Walled-off Necrosis Research Articles

Step-up approach for the treatment of infected necrotising pancreatitis: real life data from a single-centre experience with long-term follow-up

BackgroundAbout 20% of patients with acute pancreatitis develop a necrotising form with a worse prognosis due to frequent appearance of organ failure(s) and/or infection of necrosis. Aims of the present study was to evaluate the “step up” approach treatment of infected necrosis in terms of: feasibility, success in resolving infection, morbidity of procedures, risk factors associated with death and long-term sequels.MethodsIn this observational retrospective monocentric study in the real life, necrotizing acute pancreatitis at the stage of infected walled-off necrosis were treated as follow: first step with drainage (radiologic and/or endoscopic-ultrasound-guided with lumen apposing metal stent); in case of failure, minimally invasive necrosectomy sessions(s) by endoscopy through the stent and/or via retroperitoneal surgery (step 2); If necessary open surgery as a third step. Efficacy was assessed upon to a composite clinical-biological criterion: resolution of organ failure(s), decrease of at least two of clinico-biological criteria among fever, CRP serum level, and leucocytes count).ResultsForty-one consecutive patients were treated. The step-up strategy: (i) was feasible in 100% of cases; (ii) allowed the infection to be resolved in 33 patients (80.5%); (iii) Morbidity was mild and rapidly resolutive; (iv) the mortality rate at 6 months was of 19.5% (significant factors: SIRS and one or more organ failure(s) at admission, fungal infection, size of the largest collection ≥ 16 cm). During the follow-up (median 72 months): 27% of patients developed an exocrine pancreatic insufficiency, 45% developed or worsened a previous diabetes, 24% had pancreatic fistula and one parietal hernia.ConclusionsBeside a very good feasibility, the step-up approach for treatment of infected necrotizing pancreatitis in the real life displays a clinico-biological efficacy in 80% of cases with acceptable morbidity, mortality and long-term sequels regarding the severity of the disease.

Postponed endoscopic necrosectomy results in a lower rate of additional intervention for infected walled-off necrosis

Although endoscopic necrosectomy (EN) is more frequently used to manage walled-off necrosis (WON), there is still debate over how much time should pass between the initial stent placement and the first necrosectomy. This study aims to determine the effect of performing EN within different timings after placing the initial stent on clinical outcomes for WON. A retrospective study on infected WON patients compared an early necrosectomy within one week after the initial stent placement with a necrosectomy that was postponed after a week. The primary outcomes compared the rate of clinical success and the need for additional intervention after EN to achieve WON resolution. 77 patients were divided into early and postponed necrosectomy groups. The complete resolution of WON within six months of follow-up was attained in 73.7% and 74.3% of patients in both the early and postponed groups. The early group tended to a greater need for additional intervention after EN (26.8% early necrosectomy vs. 8.3% postponed necrosectomy, P = 0.036). Our study does not demonstrate that early necrosectomy is superior to postponed necrosectomy in terms of clinical success rate, total count of necrosectomy procedures, procedure-related complications, length of hospitalization and prognosis. Conversely, patients in the postponed group received fewer additional interventions.

External pancreatic fistula as a risk factor for erosive complications in patients with infected walled-off necrosis

External pancreatic fistula as a risk factor for erosive complications in patients with infected walled-off necrosis

Natural History of Asymptomatic Walled-off Necrosis in Patients With Acute Pancreatitis.

Background and objectives Studies on the natural history of asymptomatic walled-off necrosis (WON) in acute pancreatitis (AP) are scarce. We conducted a prospective observational study to look for the incidence of infection in WON. Material and methods In this study, we included 30 consecutive AP patients with asymptomatic WON. Their baseline clinical, laboratory, and radiological parameters were recorded and followed up for three months. Mann Whitney U test and unpaired t-tests were used for quantitative data and chi-square and Fisher's exact tests were used for qualitative data analysis. A p-value <0.05 was considered significant. Receiver operating characteristic curve (ROC) analysis was done to identify the appropriate cutoffs for the significant variables. Results Of the 30 patients enrolled, 25 (83.3%) were males. Alcohol was the most commonetiology. Eight patients (26.6%) developed an infection on follow-up. All were managed by drainage either percutaneously (n=4, 50%) or endoscopically (n=3, 37.5%). One patient required both. No patient required surgery and there was no mortality. Median baseline C-reactive protein (CRP) was higher in infection group 76 (IQR=34.8) mg/L vs asymptomatic group, 9.5 mg/dl (IQR=13.6), p<0.001. IL-6 and tumor necrosis factor (TNF)-alpha was also higher in the infection group. The size of the largest collection (157.50±33.59 mm vs 81.95±26.22 mm, P<0.001) and CT severity index (CTSI) (9.50±0.93 vs 7.82±1.37, p<0.01) were also higher in infection group as compared to the asymptomatic group. ROC curve analysis of baseline CRP (cutoff 49.5mg/dl), size of WON (cutoff 127mm) andCTSI (cutoff of 9) showed AUROC (area under ROC) of 1, 0.97, and 0.81 respectively for the future development of infection in WON. Conclusion Around one-fourth of asymptomatic WON patients developed an infection during three-months follow-up. Most patients with infected WON can be managed conservatively.

Percutaneous Endoscopic Necrosectomy of Walled-Off Necrosis in Post-ERCP Pancreatitis

Introduction: Acute pancreatitis is the most frequent complication in patients who undergo endoscopic retrograde cholangiopancreatography (ERCP), with an incidence rate of 3.5-9.7% [1]. 5-10% of these develop acute necrotizing pancreatitis, which may have a pancreatic or peripancreatic localization in 75-80% [2]. We describe a case report of post-ERCP acute necrotizing pancreatitis with walled-off necrosis (WON) treated with percutaneous endoscopic necrosectomy (PEN) [3]. Case Report: A 60-year-old man with obstructive jaundice and common bile duct stones at abdominal CT scan underwent ERCP to clear the biliary tract. In the following days, due to the onset of severe acute pancreatitis and sepsis, he repeated the abdominal CT scan where multiple necrotic collections were found around the pancreas with extension to the pelvic paracolic gutters. Following a step-up approach, targeted antibiotic therapy was started. After four weeks, it was not possible to perform Endoscopic Ultrasound-Guided drainage because of the distance from the stomach or the duodenum to the WON. Then percutaneous drainage was radiologically inserted into the collections through the left side of the abdomen of the patient to flush with hydrogen peroxide every day. Due to the persistent infection and necrosis in the collections, an esophageal fully covered self-expanding metal stent was temporarily inserted through the percutaneous fistula in order to increase the caliber of the fistula and to perform PEN. Discussion: The step-up approach suggests endoscopic or percutaneous drainage of infected WON as the first interventional method, depending on the location of the WON and the local expertise [1]. PEN is a safe and effective alternative to surgical treatment with a technical success rate of 47-93% and a complication rate of no more than 20% [4]. Conclusion: PEN is an advanced endoscopic technique that is showing promising results but still needs randomized controlled trials to establish safety and efficacy.

Transabdominal self-expandable metal stent placement as a rescue therapy for drainage of walled-off necrosis.

Video 1CT scan of a walled-off necrosis in the right pararenal space extended to the iliac area.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis.

Abstract No. 380 Predictors of necrosectomy after percutaneous drainage of infected walled-off necrosis in patients with acute necrotizing pancreatitis

The objective of this study was to identify predictors of percutaneous necrosectomy and analyse the efficacy of percutaneous drainage in infected walled-off pancreatic necrosis (WOPN).

Endoscopic Ultrasound-guided Drainage of Patients With Infected Walled-off Necrosis: Which Stent to Choose?

Endoscopic ultrasound (EUS)-guided drainage is the preferred treatment of pancreatic fluid collections (PFC). However, the choice of the stent for EUS-guided drainage in critically ill PFC cases with infected walled-off necrosis (WON) and/or organ failure (OF) remains unknown. Between January 2018 and December 2019, consecutive patients with symptomatic PFC subjected to EUS-guided drainage using biflanged metal stents (BFMS) or double-pigtail plastic stents (DPPS) were compared for technical success, clinical success, duration of the procedure, need for intensive care unit stay, duration of intensive care unit stay, ventilator need, resolution of OF, the duration for resolution of OF, complications, need for salvage percutaneous drainage or surgery and mortality. A subgroup of patients having infected WON with/without OF were analyzed separately. Among 120 patients (84.6% males) with PFC (108 WON, 22 pseudocyst) who underwent EUS-guided drainage, there was no difference in outcome parameters in BFMS and DPPS groups. Among patients with WON, clinical success was significantly higher (96.2% vs. 81.8%, P=0.04), with significantly shorter hospital stay (6 vs. 10 d) and procedure duration (17.18±4.6 vs. 43.6±9.7 min, P<0.0001) in the BFMS group. Among patients with infected WON with/without OF, the clinical success was significantly higher (100% vs. 73.9%, P=0.02), and the duration of the procedure was significantly lower (16.28±4.4 vs. 44.39±10.7, P<0.0001) in BFMS compared with DPPS group. EUS-guided drainage of WON using BFMS scores over DPPS. In patients having infected WON with/without OF, BFMS may be preferred over DPPS.

Endoscopic drainage versus percutaneous drainage for the management of infected walled-off necrosis: a comparative analysis

ABSTRACT Background Comparative data on percutaneous catheter drainage (PCD) vs EUS-guided drainage (EUS-D) for management of symptomatic walled-off-necrosis (WON), specially infected WON with/without organ failure(OF) is limited. Methods Patients with symptomatic WON were divided into two groups of PCD and EUS-D, depending on the modality of drainage. Resolution of OF, adverse events, and other outcome measures were recorded. The two modalities were compared among infected WON sub-cohort and also degree of solid component (SC). Results 218 patients (175 males; 80.3%) were included who underwent either PCD (n = 102) or EUS-D (n = 116). Clinical success was significantly higher in the EUS-D group (92.1% vs 64.6%; p < 0.0001) and even for infected WON (n = 128) (p = 0.004), with higher (p = 0.007) and faster (p < 0.0001) OF resolution. Other outcome measures including mortality were significantly higher in the PCD group. Among subgroups, PCD with >40% SC had the worst clinical success/OF resolution rates, while EUS-D with <40% SC had the best outcomes. Conclusion EUS-D should be preferred over PCD in the management of WON, infected or otherwise, for higher clinical success, and higher/faster resolution of OF. PCD should be avoided in WON with>40% SC.

Lumen apposing metal stents vs. double pigtail plastic stents for the drainage of pancreatic walled-off necrosis.

Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes. The aim of this study was to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON. Thirty patients were enrolled between 2011 and 2017. The present study is a single-center, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications). Cases and controls were homogeneous in terms of etiology and clinical characteristics: 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of postoperative infections, bleedings, and stent migrations (respectively 13.3% vs. 21.4%; P=0.65; 13.3% vs. 0%; P=0.48; 13.3% vs. 7.1%; P=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs. 13.3%; P=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs. 18.5 days; P<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs. 1.5; P<0.01). PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.

Triple guidance of choledochoscopy, ultrasonography, and computed tomography facilitates percutaneous catheter drainage of infected walled-off necrosis

ObjectivesPercutaneous catheter drainage (PCD) is usually performed to treat acute pancreatitis complicated by infected walled-off necrosis (WON). Insufficient drainage of infected WON may lead to a prolonged recovery process. Here, we introduce a modified PCD strategy that uses the triple guidance of choledochoscopy, ultrasonography, and computed tomography (CUC-PCD) to improve the therapeutic efficiency.MethodsThis study retrospectively analysed 73 patients with acute pancreatitis-related WON from January 2015 to January 2021. The first 38 patients were treated by ultrasonography/computed tomography-guided PCD (UC-PCD), and the next consecutive 35 patients by CUC-PCD. Perioperative data, procedural technical information, treatment outcomes, and follow-up data were collected.ResultsDemographic characteristics were statistically comparable between the two treatment groups (p > 0.05). After 48 h of PCD treatment, the CUC-PCD group achieved a significantly smaller size of the infected WON (p = 0.023), lower inflammatory response indexes (p = 0.020 for white blood cells, and p = 0.031 for C-reactive protein), and severity scores than the UC-PCD group (p < 0.05). Less catheter duration (p = 0.001), hospitalisation duration (p = 0.000), and global costs (p = 0.000) were observed in the CUC-PCD group compared to the UC-PCD group. There were no differences between the two groups regarding the rate of complications.ConclusionsCUC-PCD is a safe and efficient approach with potential clinical applicability for treating infected WON owing to its feasibility in placing the drainage catheter at the optimal location in real time and performing primary necrosectomy without sinus tract formation and enlargement.

Interventional endoscopic treatment in acute pancreatitis

Acute pancreatitis (AP) represents a frequent gastrointestinal diseases. Approximately 80% of patients have amild course of the disease and conservative treatment is sufficient; however, 20% of patients develop asevere AP with local and systemic complications. This article focuses on the currently recommended endoscopic management of severe AP. Classification of AP by the revised Atlanta classification and the occurrence of local or systemic complications. Summary of current evidence with respect to endoscopic management. Inspection of the current literature from specialist journals and current guidelines. The AP is classified as mild, moderate or severe based on systemic (hypotension, renal failure, lung failure) and/or local complications, such as acute peripancreatic fluid collections (APFC), peripancreatic pseudocysts (PPC), acute necrotic collections (ANC) and walled-off necrosis (WON). In recent years the staged endoscopic treatment of infected ANC, WON and PPC has become established. The initial step is the endoscopic ultrasound-guided puncture and drainage with plastic or lumen-apposing metal stents. For solid components or insufficient drainage, atransgastric endoscopic necrosectomy is recommended. The treatment of severe AP requires an interdisciplinary management in specialized centers and regular re-evaluation of the therapeutic efficacy. Interventional endoscopy has become established as the standard for treatment of severe AP.

A nationwide survey of acute pancreatitis:a report from 126 hospitals in China

Objective: To investigate the current status of acute pancreatitis(AP) diagnosis and treatment in hospitals of different levels in China. Methods: A cross-sectional survey was conducted. The Acute Pancreatitis Diagnosis and Treatment Practice Questionnaire was designed and sent to the members of the Group of Pancreatic Surgery Chinese Society of Chinese Medical Association Branch and some other hospitals online from 8th to 24th December, 2020. Observation indicators included general information, AP diagnosis and assessment, treatment strategies, follow-up information, and comparisons of clinical practice between 3A-level and non-3A-level hospitals were performed. Counting data was used χ 2 test or Fisher exact test. Results: A total of 126 valid questionnaires were collected in final analysis, of which 75.4% (95/126) were from 3A-level hospitals, 15.9%(20/126) and 8.7%(11/126)were from other third-level and second-level hospitals,respectively. Of all participants, 88.1% (111/126)used classic AP diagnostic criteria, and 88.1% (111/126)conducted severity assessment. The revised Atlanta classification and determinant-based classification were commonly used, accounting for 72.1%(80/111) and 22.5%(25/111), respectively. 70.6%(89/126)used predictive models, including APACHE Ⅱ score, imaging models(modified CT severity index or Balthazar scoring) and Ranson criteria. For patients with early pancreatic or peripancreatic infection, 75.4%(95/126) preferred antibiotic therapy, and for those with infected walled-off necrosis, 61.1% (77/126) preferred percutaneous catheter drainage.When surgical intervention required,preferred methods were laparoscopic transabdominal surgery(37.3%, 47/126) and open surgery(25.4%,32/126). 61.1%(77/126) accepted "delayed surgery" notion. 32.5%(41/126) routinely used the step-up approach. For mild biliary acute pancreatitis, 44.4%(56/126) underwent cholecystectomy during the same hospital admission. Regarding follow-up, ideal overall follow-up periods were 6 months(46.0%,57/124) and 12 months(33.1%, 41/124), and follow-up interval was 3 months(50.8%,63/124) and 1 month(23.4%, 29/124). Comparing clinical practice of AP between 3A-level hospitals and non-3A-level hospitals, we found that the former had a significantly higher proportion of annual AP admission number of over 100(34.7%(33/95) vs.12.9%(4/31), χ 2=5.372, P=0.020), and higher proportion of routine severity assessment(68.4%(65/95) vs. 35.5%(11/31), χ²=11.107, P=0.004), higher proportion of routine severity prediction(45.3%(43/95) vs. 12.9%(4/31), χ²=13.549, P=0.001). When surgical intervention required, the proportion of step-up approach was significantly higher(37.9%(36/95) vs.16.1%(5/31), χ 2=8.512, P=0.017). Significantly more participants preferred that follow-up should be completed by full-time staff(35.8%(34/95) vs. 22.6%(7/31), χ²=8.154, P=0.043) in 3-A level hospitals. Conclusions: The standardization of AP diagnosis is relatively high in China. However, standardized assessment of severity and prediction need to be further prompted, especially in non-3A-level hospitals. Regarding AP treatment, especially the minimally invasive intervention strategy would be the focus of the promotion of standardized AP practice in the future.

ID: 3526758 ENDOSCOPIC VERSUS PERCUTANEOUS DRAINAGE FOR THE MANAGEMENT OF INFECTED WALLED OFF NECROSIS: TIME FOR A PARADIGM SHIFT?

Symptomatic walled-off necrosis (WON) can be managed by either percutaneous catheter drainage (PCD) or EUS guided drainage (EUS-D), but there is limited data comparing the two. Moreover, infected WON with/ without organ failure (OF) is a still more difficult cohort to manage and the two modalities have not been compared in this subgroup.

Necrosectomía endoscópica percutánea en el manejo step-up de walled-off necrosis

The drainage of liquid pancreatic collections is complex and technically challenging as for Its technique. In recent decades, endoscopic advances have improved technical and clinical success rates with reduced complications. We present a case of a 72-year-old male patient with severe necrotizing acute pancreatitis after endoscopic papillectomy for recurrent papillary adenoma, with evolution to infected walled-off necrosis. Percutaneous drainage guided by tomography was performed with poor clinical evolution and persistence of collections, predominantly in the tail of the pancreas of solid necrotic remains and air bubbles. Due to the location of the collection and the absence of contact with the gastric wall, percutaneous endoscopic necrosectomy was performed with placement of a self-expanding esophageal metal stent with resolution of the case. This unusual technique is proposed in a step-up approach to the management of walled-off necrosis, when the percutaneous drainage is insufficient and the transgastric endoscopic approach is not possible due to the characteristics of the collection. The management of walled-off necrosis as a late complication of acute necrotizing pancreatitis suggests a step-up approach. Endoscopic necrosectomy achieves higher resolution rates with a lower complication rate, resolution time, and cavity recurrence.

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

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.

Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis.

Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53% CONCLUSIONS: Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics.

Spontaneous Rupture of Infected Walled-Off Necrosis in the Transverse Colon with a Nonoperative Favorable Outcome: A Rare Event

AbstractInfected walled-off necrosis (WON) is a well-known complication of acute necrotizing pancreatitis, with higher mortality and morbidity. An infected or symptomatic WON requires drainage. Occasionally, WON may spontaneously fistulize into the gastrointestinal lumen or may rupture into the peritoneum. We describe a case of spontaneous rupture of WON in the transverse colon with uncomplicated spontaneous resolution, which is an extremely rare event.

2931 Lumen-Apposing Metal Stent for Treating Pancreatic Fluid Collections in Patients at Sarasota Memorial Hospital: A Quality Improvement Initiative to Compare Outcomes With Meta-Analysis Benchmarks

INTRODUCTION: Acute pancreatitis can result in four different subtypes of fluid collections including acute peri-pancreatic fluid collection, pseudocyst, acute necrotic collection, 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. METHODS: 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. RESULTS: 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; Tables 1 and 2. CONCLUSION: 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.