Aims:
Endoscopic necrosectomy with metal stents, especially lumen apposition metal stents
(LAMS), is increasingly being used for the treatment of complicated walled-off pancreatic
necrosis (WOPN), but the need for necrosectomy is not well understood. The aim of
this study is to evaluate clinical, endoscopic and radiologic predictors for the need
of necrosectomy in patients treated with LAMS.
Methods:
Patients with WOPN treated with LAMS from 2014 to 2017 in our unit were retrospectively
reviewed. Data was obtained from medical records and reviewed by endoscopist and radiologist.
Clinical success was defined as the percentage of patients without need for surgery.
Necrosectomy was performed only when clinically needed (i.e. fever or hemodynamic
instability during follow-up). Predictors for the need of necrosectomy were evaluated
with univariate analyses.
Results:
Eighteen patients were analyzed. Three were excluded due to early decease (2 intestinal
perforation and 1 pancreatitis recurrence and advanced age). Among the remaining 15,
67% were men with mean age of 66 ± 14 years. One immediate adverse event occurred
(7%) as the stent migrated to the gastric cavity during deployment, but was relocated
in the same procedure. All 15 patients solved without need for surgery, but 5 (33%)
required necrosectomy (4 multiple necrosectomy sessions, 1 only irrigation). The percentage
of necrosis detected in the previous CT scan (47 ± 20% vs. 15 ± 18%, p = 0,008), and
the purulent aspect of the fluid drained (100% vs. 40%; p = 0,044) predicted the need
for necrosectomy in the univariable analysis, but only the first in the multivariable
(p = 0,042). Other factors as age, gender, collection characteristics on CT scan (size,
number, distance to stomach, or density) or EUS, or indication for drainage were not
significant.
Conclusions:
Percentage of necrosis detected in the CT scan previous to WOPN drainage with LAMS
might predict the need for necrosectomy.
