P0637 - Hydrogen Peroxide-Assisted Endoscopic Necrosectomy of Pancreatic Walled-Off Necrosis, Is There a Clinical Benefit? A Systematic Review and Meta-Analysis

Babu Mohan, MD¹, Deepak Madhu, MD, MRCP, DM², Gregory Toy, MD¹, Saurabh Chandan, MD³, Shahab R. Khan, MBBS⁴, Lena Kassab, MD, MBA⁵, Antonio Facciorusso, MD, PhD⁶, Mohammad Bilal, MD⁷, Iqbal Sandhu, MD⁸, Douglas Adler, MD^9
1University of Utah School of Medicine, Salt Lake City, UT; ²Caritas Hospital, Kottayam, Kerala, India; ³Creighton University School of Medicine, Omaha, NE; ⁴Brigham & Women's Hospital, Harvard Medical School, Boston, MA; ⁵Mayo Clinic, Rochester, MN; ⁶University of Foggia, Foggia, Puglia, Italy; ⁷Minneapolis VA Health Care System, Minneapolis, MN; ⁸VA Salt Lake City, Salt Lake City, UT; ⁹Center for Advanced Therapeutic Endoscopy, Salt Lake City, UT

Introduction: Hydrogen peroxide (H2O2) is an inorganic chemical agent that has been used in wound debridement owing to its antiseptic, sporicidal, hemostatic and wound healing properties at low concentrations (3%). The removal of necrotic debris is an integral part of the endoscopic management of pancreatic walled-off necrosis (WON). H2O2 has been evaluated as an agent to facilitate extraction of necrotic debris in WON in multiple studies. We conducted a systematic review and meta analysis to study the pooled clinical outcomes of using H2O2 in debridement of WON.

Methods: Multiple databases including Medline, Embase, and Scopus were searched, and studies were considered that evaluated the use of H2O2 in debridement of WON. Standard meta-analysis methodology using the random-effects model was used for calculating the pooled rates of technical and clinical success, along with adverse events and its subtypes. Heterogeneity in the study was assessed using I2% and 95% prediction interval statistics.

Results: A total of 7 studies (186 patients) were included in the final analysis. Variability was noted on the formulation of H2O2 used for debridement (0.1%, 0.3%, 3% strength) and number of sessions ranged from 2 to 5. Three studies used lumen apposing metal stents, and the rest utilized a self expanding metal stent.
Clinical success was defined as either resolution of WON and/ or absence of recurrence. The pooled technical success was 95.8% (95% CI [88.5-98.5]), and clinical success was 91.6% [86.1-95]. The pooled rate of cumulative adverse events was 19.3% [7.6-41], bleeding was 7.9% [2.4-22.7], stent migration was 11.3% [4.9-23.9], perforation was 5.4% [1.7-15.7], infection was 5.7% [2-15.1], and respiratory complications was 2.9% [1.3-6.1]. Minimal to moderate heterogeneity was noted (Table-1).

Discussion: Based on this meta-analysis, use of H2O2, as an adjunct in debridement of WON, demonstrated high technical and clinical success. However, bleeding of 7.9% and stent migration of 11.3% seems high. A maximum of 4 to 5 treatment sessions seems high. Further well-designed comparative studies with and without H2O2 are warranted to establish the benefit of using H2O2 in the endoscopic necrosectomy of pancreatic WON.



Disclosures:


Babu Mohan, MD¹, Deepak Madhu, MD, MRCP, DM², Gregory Toy, MD¹, Saurabh Chandan, MD³, Shahab R. Khan, MBBS⁴, Lena Kassab, MD, MBA⁵, Antonio Facciorusso, MD, PhD⁶, Mohammad Bilal, MD⁷, Iqbal Sandhu, MD⁸, Douglas Adler, MD⁹. P0637 - Hydrogen Peroxide-Assisted Endoscopic Necrosectomy of Pancreatic Walled-Off Necrosis, Is There a Clinical Benefit? A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.