LUMEN APPOSING METAL STENT HOT AXIOS IN ACUTE PANCREATITIS WALLED-OFF NECROSIS: COMPARISON STUDY BETWEEN 15 MM AND 20 MM STENT

Aims The objective of this study is to compare the efficiency related to different sizes (15 mm vs 20 mm) of HOT AXIOS stents in the endoscopic treatment of AP collections.

Methods This is a monocentric retrospective study performed in Beaujon Hospital. The inclusion criteria were: placement of an AXIOS of 15 or 20 mm for the treatment of a PA (walled-off necrosis) symptomatic collection (suspicion of infection, compression of organ). The success of endoscopic treatment was defined by a composite criterion which was success without any surgical treatment and survival. Univariate and multivariate analyzes focused on the factors associated with the success of endoscopic treatment and those associated with 15 and 20 mm stent.

Results From May 2016 to May 2019, 97 patients underwent endoscopic drainage with a HOT AXIOS stent. 52 patients were actually treated for PA collections. The mean total length of endoscopic procedure was 122 ± 125 min for an average number of necrosectomies of 1.77 ± 1.89 per patient. Seven patients (13%) died.

Endoscopic management resulted in success for 41 (79%) patients including 27/29 (93%) in the group of AXIOS of 15 mm and 14/23 (61%) in the group of AXIOS of 20 mm (p = 0.007).

In multivariate analysis, patients with AXIOS 20 mm had a significantly lower Charlson score

(p = 0.04), a greater total duration of necrosectomy (p = 0.03), less nasocystic drain (p = 0.008) and more frequent failure of endoscopic treatment (p = 0.03).

Conclusions The efficiency of HOT AXIOS stent of 20 mm seems to be lower than that of 15 mm stent in the endoscopic treatment of necrotic post PA collections, with a potential risk of increased bleeding.