A0024 - Safety and Efficacy of Endoscopic Drainage of Pancreatic Fluid Collections Performed by Early Career Advanced Endoscopists: A Multicenter Experience

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Nicholas McDonald, MD

University of Minnesota
Minneapolis, MN

Nicholas McDonald, MD¹, Rushikesh Shah, MD², Natalie Wilson, MD¹, James D. Haddad, MD³, Munish Ashat, MD⁴, Jagpal Klair, MD⁵, Corey Miller, MD⁶, Mohamed Abdallah, MD¹, Shawn L. Shah, MD³, Mohammad Bilal, MD⁷
¹University of Minnesota, Minneapolis, MN; ²Baylor University Medical Center, Dallas, TX; ³Dallas VA Medical Center, Dallas, TX; ⁴University of Iowa Hospitals and Clinics, Iowa City, IA; ⁵Kaiser Permanente Seattle, Seattle, WA; ⁶McGill University, Montreal, PQ, Canada; ⁷University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Over the past decade, endoscopic ultrasound (EUS) guided drainage has become the gold standard in management of symptomatic pancreatic fluid collections (PFCs). While there are ample data showing the safety and efficacy of endoscopic drainage of PFCs, these data are largely derived from expert advanced endoscopists. Comparatively, there is little published on outcomes of endoscopic drainage of PFCs performed by early career advanced endoscopists. We aimed to evaluate the safety and efficacy of endoscopic drainage of PFCs performed by early career advanced endoscopists.

Methods: This was a multicenter, retrospective analysis of all patients who underwent EUS-guided drainage of PFCs, performed by 6 early career advanced endoscopists (defined as within 2 years of graduating advanced endoscopy fellowship). Patient and procedure characteristics were recorded. Procedure characteristics included type and location of collection, type and size of stent placed and location of stent placement. Primary outcomes were technical and clinical success. Other outcomes included adverse events and procedure-related mortality.

Results: A total of 24 patients underwent endoscopic drainage of PFCs. The mean age was 53 years and 21% were female [Table 1]. Median duration of follow-up was 90 days. Three patients (12.5%) were anticoagulated. The average Charlson Comorbidity Index was 2.3. The collections included pseudocysts (37.5%%), walled-off necrosis (45.8%) and post-surgical collections (16.7%). The location was peripancreatic in 10 cases (41.7%) and pancreatic in 14 cases (58.3%). The PFC drainage approach was transgastric in 22 cases (91.7%) and transduodenal in 2 cases (8.3%). The primary drainage modality was lumen-apposing metal stents (LAMS) in 21 cases (87.5%) and plastic stents in 3 cases (12.5%). Clinical success was achieved in 22 cases (91.7%) and technical success in 23 cases (95.8%). The only adverse event was LAMS maldeployment in 1 case (8%), which was immediately removed and the defect closed with an over-the-scope clip without immediate or delayed bleeding or perforation. One patient (8%) had delayed bleeding during subsequent necrosectomy and underwent angioembolization by interventional radiology. There was no procedure-related mortality during the study period.

Discussion: We found that endoscopic drainage of pancreatic fluid collections is safe and effective in the hands of early career advanced endoscopists, with outcomes comparable to those reported by later career endoscopists.

	n = 24
Patient characteristics
Age, years	53 (SD 14)
Female	5 (21%)
Inpatient	9 (56%)
Platelets (K/cmm)	298
INR	1.13
Any anticoagulation Argatroban Apixaban Warfarin	3 (12.5%) 1 (4.2%) 1 (4.2%) 1 (4.2%)
Charlson Comorbidity Index, average	2.6
Collection Type Pseudocyst Walled-off necrosis Post-surgical collection	9 (37.5%) 11 (45.8%) 4 (16.7%)
Collection Location Peripancreatic Pancreatic Head Body/Tail Entire pancreas	10 (41.7%) 14 (58.3%) 2 9 3
Procedure characteristics
Site of EUS Pancreatic Drainage Stomach Duodenum	22 (91.7%) 2 (8.3%)
Native Anatomy	23 (95.8%)
Stent used LAMS Plastic	21 (87.5%) 3 (12.5%)
LAMS Size 10 mm x 10 mm 15 mm x 10 mm 20 mm x 10 mm	2 (9.5%) 14 (66.7%) 5 (23.8%)
Clinical Success	22 (91.7%)
Technical Success	23 (95.8%)
Adverse events LAMS maldeployment Bleeding Stent migration	1 (4.2%) 0 0
Post-procedural pain within 30-days	3 (12.5%)
Need for admission within 30-days	7 (29.2%)
Death within 30-days	0
Stent removed	19 (79.2%)
Mean time until stent removed, days, SD	27 (SD 22)
Mean number of GI interventions	1.6
Duration of follow-up median, days	90

Table: Table 1. Patient and procedure characteristics

Disclosures:

Nicholas McDonald indicated no relevant financial relationships.

Rushikesh Shah indicated no relevant financial relationships.

Natalie Wilson indicated no relevant financial relationships.

James Haddad indicated no relevant financial relationships.

Munish Ashat indicated no relevant financial relationships.

Jagpal Klair indicated no relevant financial relationships.

Corey Miller indicated no relevant financial relationships.

Mohamed Abdallah indicated no relevant financial relationships.

Shawn Shah indicated no relevant financial relationships.

Mohammad Bilal indicated no relevant financial relationships.

Nicholas McDonald, MD¹, Rushikesh Shah, MD², Natalie Wilson, MD¹, James D. Haddad, MD³, Munish Ashat, MD⁴, Jagpal Klair, MD⁵, Corey Miller, MD⁶, Mohamed Abdallah, MD¹, Shawn L. Shah, MD³, Mohammad Bilal, MD⁷. A0024 - Safety and Efficacy of Endoscopic Drainage of Pancreatic Fluid Collections Performed by Early Career Advanced Endoscopists: A Multicenter Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.