FOUR YEARS OF EUS-GUIDED PANCREATIC FLUID COLLECTION DRAINGE: OUR EXPERIENCE AT ST JAMES´ HOSPITAL

Aims To examine our centre’s experience with the LAMS for pseudocyst drainage over the first four years of its use.

Methods Data from January 2016-August 2019 was retrospectively reviewed. Size of collection, insertion route, progress, date of removal, resolution of collection, complications and mortality were all recorded. Analysis was descriptive in nature.

Results 20 patients had a LAMS inserted during the study period, with pseudocyst or walled off necrosis as the indication. Mean size of collections was 79mm (median 74mm, rang 50-150mm). 19/20 were inserted via transgastric route, 1/20 was inserted through the duodenum. All patients had a 15x10mm stent inserted. Mean number of days before removal was 49 (data missing on two patients).

Two patients had immediate arterial bleeds, but haemostasis was quickly achieved using balloon dilatation, and expansion of the stent. One patient’s stent was dislodged, but was removed using a grasper and resulted in no complication. One patient had a buried LAMS, which had to be resected from within gastric wall endoscopically. One patient had a free perforation, as the cyst was not as well defined as appeared on cross sectional imaging and CT. This was managed conservatively.

In terms of mortality, there were no deaths at 30 days post procedure. One patient died eight weeks post insertion, from overwhelming sepsis; this patient had their stent inserted for palliative purposes, so this was not unexpected. One patient had a recurrence of his collection upon recommencement of excessive alcohol use.

Conclusions Our centre has experienced low rates of migration/dislodgement (5%), low rates of complications (10%) and 5% one year mortality. These results are on a par with other centres internationally. Regular use of LAMS for management of this cohort of patients is important in reducing morbidity and mortality, as well as improving quality of life post severe acute pancreatitis.