Endoscopic Ultrasound-Guided Versus Percutaneous Catheter Drainage for the Management of Infected Walled off Necrosis: Which and Why?

Aims Symptomatic walled-off-necrosis (WON) is managed by either percutaneous catheter drainage (PCD) or EUS-guided drainage (EUS-D), but limited data exist comparing the two, and infected WON with/without organ failure (OF) is still more difficult to manage.

Methods Patients with symptomatic WON were divided into two groups of PCD and EUS-D, depending on the modality of drainage. Clinical success was defined as resolution of symptoms, collection, and OF without the need for an alternative procedure/surgery. Adverse events, secondary infection rates, and other outcome measures were recorded. The two modalities were compared for those with infected WON with/without OF and analyzed additionally in terms of the degree of solid component (SC).

Tab. 1

Sub-group of Infected WON	EUS-D (n = 45)	PCD (n = 83)	p value
Clinical success	39 (86.7 %)	51 (62.2 %)	0.004
Resolution of OF	24/27 (88.9 %)	39/66 (59.1 %)	0.007
Time to resolution of OF (days)	3.08±1.3	10.31±4.9	<0.0001
Mortality	3 (6.7 %)	27 (32.5 %)	0.001

Results 218 patients (175 males; 80.3 %) underwent either PCD (n = 102) or EUS-D (n = 116). Clinical success was significantly higher in the EUS-D arm (92.1 % vs 64.6 %; p<0.0001). Among patients with infected WON (n = 128), clinical success was significantly higher in the EUS-D arm (86.7 % vs 62.2 %; p=0.004) with higher (p=0.007) and faster (p<0.0001) OF resolution. All other outcome measures such as need for ICU/ventilator support, length of ICU or hospital stay, surgery, and mortality were significantly higher in the PCD arm. A multivariate model showed EUS-D as a significant positive predictor (p=0.03) for clinical success in infected WON. Based on mode of drainage and degree of SC, PCD with > 40 % SC evidently had the worst clinical success with higher adverse outcomes while EUS-D with < 40 % SC had the best outcomes.

Conclusions This is the largest data to show that EUS-D should be preferred over PCD in the management of WON, infected or otherwise, with higher clinical success, higher and faster resolution of OF with lower rates of reintervention, adverse events, and better survival. While EUS-D will be preferred in all feasible cases of WON, PCD should be avoided in WON with > 40 % SC.

Citation: Samanta J, Dhar J, Muktesh G et al. OP166 ENDOSCOPIC ULTRASOUND-GUIDED VERSUS PERCUTANEOUS CATHETER DRAINAGE FOR THE MANAGEMENT OF INFECTED WALLED OFF NECROSIS: WHICH AND WHY?. Endoscopy 2021; 53: S67.

Publication History

Article published online:
19 March 2021