Long-Term Outcomes of Endoscopic Drainage Modalities in Patients with Pancreatic Fluid Collections Following Acute Pancreatitis: a multicenter retrospective cohort study

Aims This study aims to evaluate current practices in managing pancreatic fluid collections, identify trends over time, and assess predictors of clinical improvement and collection resolution following various drainage procedures.

Methods An international multicenter cohort study was conducted across three institutions from 2016 to 2023. Patients with radiologically confirmed pancreatic fluid collections were included. The primary outcome was the time to clinical improvement post-drainage, defined as resolution of indications for drainage. Secondary outcomes included complications, readmissions, and rates of collection resolution.

Results 403 patients were included in the final analysis. The median age of participants was 56 years (IQR: 24.5), and the cohort was predominantly male (75.8%). Comorbidities included hypertension (41.7%), diabetes (21.3%), and coronary artery disease (16.6%). The most common etiologies of pancreatitis were alcohol misuse disorder (40.0%) and biliary causes (27.8%). Severity classification revealed mild pancreatitis in 46.2%, moderate in 39.0%, and severe in 14.6%. The majority of patients presented with walled-off pancreatic necrosis (62.8%), and 44.7% required drainage due to infection. Endoscopic interventions included lumen-apposing metal stents (46.4%), bi-flanged metal stents (39.2%), and double pigtail stents (12.5%). Adverse events were rare, with a bleeding rate of 0.25% and a stent migration rate of 1.99%. At follow-up, 79.4% of patients achieved resolution of fluid collections, with a total follow-up time of 192.6 person-years and a median follow-up of 190 days (IQR: 267.5). The overall resolution rate was 76.4%. Reintervention was required in 24.8% of patients, with 55% of these requiring endoscopic re-stenting. The median time to reintervention was 108 days (IQR: 244). Factors associated with faster recovery after drainage, as identified through Cox regression, included LAMS placement (HR=1.8, [1.44, 2.35], P<0.001) and peripancreatic involvement only (HR=1.2, [1.02, 1.31], P=0.02). Older age, female sex, and the location of the procedure were not significantly associated with recovery time (Age: HR=1.0, [0.99, 1.01], P=0.43; Sex: HR=1.1, [0.85, 1.37], P=0.53). Factors predictive of longer resolution times included repeat pancreatitis (HR=0.56, [0.37, 0.83], P=0.004), multiorgan failure (HR=0.45, [0.27, 0.76], P=0.003), and walled-off necrosis as the type of pancreatic fluid collection (HR=0.75, [0.59, 0.94], P=0.01). Predictors of procedure failure, identified through logistic regression, included age (OR=1.0, [1.00, 1.03], P=0.06), multi-organ failure (OR=6.3, [3.04, 13.18], P<0.001), and walled-off necrosis (OR=2.54, [1.41, 4.57], P=0.002). Factors associated with improvement included biliary (OR=0.39, [0.21, 0.75], P=0.005) and chronic pancreatitis etiology (OR=0.48, [0.02, 0.23], P<0.001) [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11].

Conclusions In conclusion, our study underscores the complexity of managing pancreatic fluid collections, emphasizing the role of timely interventions and stenting strategies in clinical outcomes.

Publication History

Article published online:
27 March 2025

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