Endoscopic Pancreatic Necrosectomy Technique: Know Your “How” to Justify Your “Why”: 907

INTRODUCTION: Walled-off necrosis (WON) is a feared complication of acute pancreatitis that carries significant morbidity. Direct endoscopic necrosectomy (DEN) is preferred over surgical one due to its minimally invasive nature and lower complication rates. However, no endoscopic technique and/or device has been adopted as a gold standard; and endoscopists differ significantly in their DEN preferences. The primary aim of this study was to report our DEN technique and its outcomes. METHODS: Medical records of patients who underwent EN from September 2016 – May 2019 were reviewed. Continuous data was described using mean and standard deviation (SD); categorical data as frequency and proportion (%); and interval data as median and (range). RESULTS: A total of 20 patients underwent DEN after initial drainage with a 10 × 15 mm electrocautery enhanced AXIOS lumen apposing metal stent (LAMS) (Table 1). A total of 23 LAMS were placed (22 trans-gastric and 1 trans-duodenal) Technical success (LAMS correctly deployed between the cavity and the gastric/duodenal lumen) was achieved in 100% of cases. All LAMS were dilated to 15 mm the same day of deployment, and the mean interval from drainage to first DEN was 5.4 days. DEN was repeated until the cavity was empty. A total of 66 DEN were performed. The mean number of DEN/patient was 3.3; each with a mean duration of 50 min. The most commonly used endoscope and device was the single channel gastroscope (83%) and the 27 mm snare (93.9%), respectively. The mean interval between each DEN was 7 days. All LAMS were removed after a mean of 27 days. Three patients were lost to follow up. After a median follow-up time of 14 months (1-28), clinical success (resolution of WON by imaging and patient’s symptoms on follow up visit) was achieved in 94% of cases. Only 1 subject had a major complication (cavity wall rupture with pneumoperitoneum that required surgery). Minor non-life-threatening complications occurred in 9 subjects (Table 2). CONCLUSION: At our center, the most commonly used endoscope and device to perform DEN is the single channel gastroscope and the 27 mm snare, respectively. An average of 3 DEN are required per patient, each one averaging 50 min. Our DEN technique is safe and effective in the management of WON, achieving clinical success in 94% of cases with minimal morbidity and no mortality.