Endoscopic Cystgastrostomy and Necresectomy of Large Walled-Off Necrosis (Retrospective Study)

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Pancreatic walled-off necrosis (WON) is a severe complication of acute pancreatitis, often requiring intervention. This retrospective study evaluates the efficacy and safety of endoscopic cystgastrostomy using lumen apposing metal stent (LAMS) and double pigtail catheters, and endoscopic necresectomy sessions, in treating large WON ($10 cm). Methods: We retrospectively analyzed patients with large pancreatic WON ($10 cm) treated at our institution with endoscopic cystgastrostomy using LAMS and double pigtail catheters, combined with endoscopic necresectomy. Data on patient demographics, etiology of pancreatitis, indications for drainage, procedural success, complications, and recurrence rates were collected. Results: A total of 28 patients were included in the study. The mean age was 49.6 years, and 57.1% were male. The size of the pseudocysts on initial CT ranged from 10.0 to 31.0 cm, with a median size of 16.1 cm and a mean size of 16.8 cm. Etiologies of pancreatitis included biliary (40.7%), alcohol-related (29.6%), idiopathic (14.8%), iatrogenic post-ERCP (11.1%), and iatrogenic post-surgery (3.7%). Indications for drainage were primarily abdominal pain (50%), followed by sepsis (25%). The clinical success rate was 89.3%, with a technical success rate of 100%. Complications occurred in 21.4% of patients, including stent migration and infection. The recurrence rate of fluid collections was 39.3%. Pancreatic duct disruption was present in 39.3% of patients, with a median of 2 ERCPs required (mean: 2.9). The median number of endoscopic necrosectomies was 2 (mean: 2.7). The median number of EGDs post-EUS cystgastrostomy was 2. The mean hospital admission length was 6.6 days for the initial cystgastrostomy procedure admission. LAMS sizes were 15 x 10 mm in 96.3% of cases and 10 x 10 mm in 3.7% of cases. The rate of IR drain usage was 35.7%, and 32.1% of cases had fluid collections extending to the pelvis. Conclusion: Endoscopic cystgastrostomy with LAMS and double pigtail catheters, along with endoscopic necresectomy, is an effective treatment for large pancreatic WON ($10 cm), demonstrating high clinical and technical success rates. However, the high recurrence rate reported was related to PD disruption that required endoscopic therapy for treatment (ERP). Careful patient selection and post-procedure monitoring with imaging, office visits and targeted endoscopic therapy are essential to achieve high clinical success

Volume

119

Issue

10S

First Page

S14

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

DOI

10.14309/01.ajg.0001028440.89874.b4

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