Su1370 COMPREHENSIVE ANALYSIS OF ADVERSE EVENTS ASSOCIATED WITH ENDOSCOPIC ULTRASOUND DRAINAGE OF PANCREATIC FLUID COLLECTION: AN INTERNATIONAL MULTICENTER STUDY

The use of lumen-apposing metal stents (LAMS) for the management of pancreatic fluid collections (PFCs) has recently increased significantly. Recent studies reported high clinical success rate. However, there has been a concern with occurrence of adverse events (AEs) related to this relatively new practice. There is scarce literature on AEs related to the use of LAMS in the management of PFCs. To evaluate the incidence, severity, and management of AEs related to the use of LAMS for the drainage of PFCs. This is a multicenter, international, retrospective study at 15 multinational centers. All patients who underwent LAMS (Axios or Electrocautery enhanced (EC)-AXIOS, BSCI) placement for the management of pancreatic pseudocysts (PP) or walled off necrosis (WON) between 03/2013 and 10/2017 were included. Intraprocedural and post-procedural AE’s were recorded, classified and graded according to the ASGE lexicon. During the study period, a total of 333 patients (female 35.1%, mean age 56yr ± 15.84yr) were identified table 1. The mean diameter of PFCs was 113.11± 58.98 mm and were most commonly located in the pancreatic body (54.95%). LAMS were placed for the the treatment of PP in 166 patients and WON in 167 patients. A total of 335 LAMS were used, with 2(0.6%) patients being treated with 2 LAMS. A 15mm diameter stent was placed in 225/335(67.2%). EC-LAMS was used in 303/335(90.4%). Technical success was achieved in 324 (96.7 %) cases with a mean procedural time of 32.4min ± 22.95. Clinical success (resolution of PFC) was achieved in 286 (85.9%) patients and LAMS were removed after a mean of 59 days (95% CI: 52.9-65.2). AE’s associated with the use of LAMS occurred in 89/333(26.6%, 95% CI: 18.9-36.1%) of cases. A total of 98 AEs occurred with 2 AEs occurring in 9 (2.7%) patients. Characteristics and management of AE’s are listed in table 2. Death occurred in 9 cases. The mean time between stent placement and occurrence of AEs was 22.8 (95% CI:16.6-29.9; range 0-146) days. Data from this large international study confirm that the use of LAMS stent for management of PFCs has excellent technical and clinical success rates. The rate of complications including fatal events, however, is not negligible and should be carefully considered before using the stent in this clinical setting. Further studies are needed to determine the optimal algorithm for follow-up of LAMS placement to attempt to minimize AEs.Tabled 1Table 1. Demographic data of 333 patientsEtiologies of acute pancreatitisNRateGallstone13641.8%Alcohol8726.1%Idiopathic5516.5%Post-Operative185.4%Post ERCP Pancreatitis92.7%Trauma92.7%Autoimmune20.6%Others175.1%Indication of drainageInfection12537.5%Abdominal pain10732.1%Gastric outlet obstruction7122.3%Early satiety216.3%Rapid increase in size51.5%Jaundice41.2% Open table in a new tab Tabled 1Table 2. Characteristics of Adverse EventsAdverse EventsN(98)Rate of 333 patients(95% CIs)Bleeding236.9%(95% CI:4.5-9.9)Infection195.7%(95% CI:3.5-8.5%)Stent migration185.4%(95% CI:3.2-8.4)Stent occlusion144.2%(95% CI:2.3-7.0)Multi Organ Failure92.7%(95% CI:1.3-4.8%).Stent dislodgement92.7% (95% CI: 1.3-4.8%)Buried stent syndrome30.9% (95% CI:0.2-2.3%)Perforation10.3%(95% CI:0.02-1.3%)Others20.6%(95% CI:0.1-1.8%)ASGE severity indexN(98)Rate of 98 AEsMild3939.8%Moderate4541.8%Severe55.1%Fatal99.2%ManagementN(98)Rate of 98 AEsConservative treatment2525.5%Endoscopic stent re-placement(pig-tails/LAMS)1515.3%Endoscopic stent cleaning1111.2%Endoscopic stent removal1111.2%Endoscopic hemostasis procedure88.2%Endoscopic additional stent insertion(pig-tails/LAMS)77.1%Interventional Radiology Embolization55.1% Open table in a new tab