EUS Guided Drainage Of Non-Walled Off Organised Pancreatic Necrosis; A Tertiary Center Experience

Aims To describe the clinical outcomes in patients undergoing EUS guided pancreatic necrosectomy in non-walled off organised collections.

Methods All patients undergoing EUS guided drainage of organised pancreatic necrosis were retrospectively identified form our endoscopy data base over a two year period.

Results 12 patients (7 male, 5 female) with necrotizing pancreatitis and organised pancreatic necrosis were identified from June 2018 to October 2020. Median age was 59, ten patients had been admitted to a critical care facility. Eighteen procedures were undertaken (one procedure in 7, two in 4 and three in 1).

All patients underwent EUS-guided deployment of a Hot Axios™ stent (lumen apposing fully covered metal stent). Median stent size (radial diameter) was 15mm x 10mm (range 20mm in one, 15mm in eight, 10 in three).

Technical success was achieved in all patients. A nasocystic drain was placed through the stent into the necrosis in 3 patients. Eleven patients demonstrated improvement of the collections post stent insertion.

There were no procedure related complications. One episode of luminal bleeding occurred two days post-procedure with no source identified. Blockage of the stent was seen in four patients at 28, 22, 18 and 6 days prompting gastroscopic flushing. One patient was readmitted with sepsis of unclear aetiology.

Nine patients were discharged from hospital following intervention with a median length of stay in hospital of 5 days (range 1-97). Two of these died from multiorgan failure (157 days and 56 days post procedure). The rest have improved clinically. One died in hospital 47 days post procedure with multiorgan failure, two are still an inpatient (58 days and 49 days post procedure).

Conclusions We report on efficacy and safety in a cohort of unwell patients undergoing EUS guided pancreatic necrosectomy with large diameter Hot Axios™ stents. These stents facilitate repeated debridement and endoscopic flushing.

Citation Ahmed W, Caracostea A, Reffitt D et al. eP414 EUS GUIDED DRAINAGE OF NON-WALLED OFF ORGANISED PANCREATIC NECROSIS; A TERTIARY CENTER EXPERIENCE. Endoscopy 2021; 53: S232.

Publication History

Article published online:
19 March 2021