THE ON-DEMAND NUMBER OF NECROSECTOMY SESSIONS DURING LUMEN APPOSING METAL STENTS DRAINAGE IN WALLED-OFF PANCREATIC NECROSIS CANNOT BE PREDICTED

Aims To assess the possible prediction for the need of necrosectomy according to the amount of necrosis inside the WOPN assessed during endosonography (EUS).

Methods This is a single center prospective analysis at a single tertiary referral center. There were enrolled patients with symptomatic WOPN (pain, infection or gastric or biliary outlet obstruction) with more than 4 weeks after the onset of acute pancreatitis. The amount of necrosis was assessed by EUS in the session of LAMS placement . There were noted the clinical success regarding LAMS placement, the number of necrosectomies, the need for additional drainage (pigtail stents), the complications and the survival rate. The need for necrosectomy was performed on-demand when fever or inflammatory biological markers raised after LAMS placement. The patients were discharged when the inflammatory markers normalized and they were followed-up monthly by abdominal ultrasound and by CT scan at three months.

Results There were 28 patients included and more than half were infected. The median size of the PFC was 108mm (IQR: 81-146). LAMS was successfully placed in all patients, without immediate complications following the procedure. Necrosis was present in all patients and one third had more than 50% of the WOPN with necrosis. Necrosectomies were performed in 25/28 (89.2%) patients. The median number of endoscopic debridement sessions was 2 (IQR: 1-4). There was no statistically significant association between the size of the PFC and number of necrosectomies performed (Spearman’s r coefficient was.153, p=0.427). The median duration until stent removal was 36 days (IQR: 24 - 55 days).

Overall, PFC resolution at 3 months follow up was noted in 24/29 (85.7%) patients.

Conclusions The size of WOPN and the amount of necrosis prior LAMS drainage of WOPN cannot predict the need for on-demand necrosectomy sessions.