Outcomes of Endoscopic Single-Gated Compared to Multi-Gated Approach in the Management of Acute Necrotic Collections and Walled Off Necrosis in Necrotizing Pancreatitis (NP)
Document Type
Abstract
Publication Date
11-1-2024
Abstract
Background: Endoscopic drainage and necrosectomy are the preferred approaches in managing NP.We aimed to study clinical outcomes in NP managed with single or multiple lumen-apposing metal stents (LAMS) among patients treated with a primary endoscopic approach. Methods: This is a multicenter retrospective cohort study involving NP patients aged ≥18 who underwent either a single-gated (SG), single-gated converted to multi-gated (SG-MA), or multi-gated (MG) EUS-guided approach toWON drainage from 2021 to 2023. The study's primary outcome was determining clinical response (resolution of symptoms or no need for intervention 1 to 6 months after index diagnosis), and secondary outcomes included the number of procedures, adverse events, long-term complications, and mortality Results:We identified 107 patients with NP, of whom 95 (88.9%) were treated with a primary endoscopic approach; 75 (70.1%), 15 (14.0%), and 16 (15.0%) underwent SG, SG-MA, and MG approaches, respectively. The three study groups did not differ in demographic, clinical, or radiological characteristics. Technical success was 100%. Clinical success was 89.3%, 86.6%, and 87.5% with SG, SG-MG, and MG approaches, respectively (P = 0.94). An MG approach was associated with a lower number of necrosectomy sessions (mean difference, -3.82 sessions; P < 0.0001), days to LAMS removal (mean difference, -25.1 days; P = 0.049), and time to clinical response (mean difference, - 118.3 days; P = 0.04) than SG-MA approach. AnMG approach was associated with a lower need for percutaneous drainage (OR = 0.681; P = 0.002). The mortality rates were 13.3% (10/75), 7.1 % (1/14), and none (0/16) in the SG, SGMG, and MG groups, respectively (log-rank Mantel-Cox P = 0.242). There was no difference in AEs between the groups (P = 0.77) Conclusions: An MG approach to WON was safe and associated with earlier clinical response, fewer endoscopic necrosectomy procedures, and shorter LAMS dwell time than an SG approach.
Publication Title
Pancreas
Volume
53
Issue
10
First Page
e926
Last Page
e926
Recommended Citation
Mohammed, A., Singh, A., Hussain, A., Mian, A., Kouanda, A., Muzaffar Khan, H., Kadkhodayan, K., Yang, D., Cosgrove, N., Jain, D., Hasan, M., & Arain, M. (2024). Outcomes of Endoscopic Single-Gated Compared to Multi-Gated Approach in the Management of Acute Necrotic Collections and Walled Off Necrosis in Necrotizing Pancreatitis (NP). Pancreas, 53 (10), e926-e926. https://doi.org/https://doi.org/10.1097/MPA.0000000000002402
Comments
American Psychological Association Annual Meeting, APA 2024 held 8/8/24 to 8/10/24 in Seattle, WA, USA.