Endoscopy 2020; 52(S 01): S167
DOI: 10.1055/s-0040-1704515
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 09:30 – 10:00 Outcomes and Adverse events in bilipancreatic endoscopy ePoster Podium 8
© Georg Thieme Verlag KG Stuttgart · New York

MEASURING THE VALUE OF ENDOSCOPIC ULTRASOUND (EUS)- GUIDED DRAINAGE OF PANCREATIC FLUID COLLECTIONS: A SINGLE CENTER COMPARATIVE STUDY OF PLASTIC AND LUMEN APPOSING METAL STENTS

V Parihar
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
,
Y Bashir
2   Tallaght University Hospital, Surgery, Dublin, Ireland
,
D Nally
2   Tallaght University Hospital, Surgery, Dublin, Ireland
,
G Mellotte
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
,
T Manoharan
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
,
C Walker
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
,
P Ridgway
2   Tallaght University Hospital, Surgery, Dublin, Ireland
,
K Conlon
2   Tallaght University Hospital, Surgery, Dublin, Ireland
,
N Breslin
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
,
G Harewood
3   Beaumont Hospital, Department of Gastroenterology, Dublin, Ireland
,
BM Ryan
1   Tallaght University Hospital, Gastroenterology, Dublin, Ireland
4   Trinity College, Department of Clinical Medicine, Dublin, Ireland
,
Tallaght Pancreas Research Group› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available ateRef
 
 

    Aims This study aimed to characterize the value of Endoscopic Ultrasound (EUS)-guided drainage of Pancreatic Fluid collections (PFCs) with either plastic or Lumen Apposing Metal Stents (LAMS).

    Tab. 1

    EUS Quality(A) and Complexity(B), four point Likert scale

    Unsuccessful procedure OR Post-procedure complication

    No sedation issues, no anticoagulation, low risk patient & straightforward drainage

    Partially successful but requiring repeat procedure

    a. Difficult sedation, ICU admission;patient>80 yearsor or <16 years, significant co-morbidity OR b. WON OR c. Complex indication (eg DPD, varices, PFC drainage through duodenum)

    Successful procedure

    Two of a, b, c

    Additional treatment, eg (necrosectomy;ERCP; Nasocystic catheters;percutaneous drainage Multigated drainage) .

    a, b & c

    Methods Single centre, retrospective-prospective comparative study of 39 patients who underwent EUS guided PFC drainage between 2009 and 2018. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure adjusted for complications, T procedure duration and C is the complexity adjustment. Quality and complexity were estimated on a 1-4 Likert scale based on American Society for Gastrointestinal Endoscopy criteria.(see table) Time (in minutes) was recorded from the patient entering and leaving the procedure room. Endoscopy time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized.

    Results Of 39 identified patients who underwent EUS-guided PFC drainage, 11 received double pigtail plastic stents (DPSSs) and 28 received LAMSs. The two groups were comparable in age, gender and aetiology. 50% of the LAMS interventions were considered high value but only 10% of the Plastic stent interventions achieved the same. The difference predominantly was due to a higher rate of complications and longer procedure time with DPSS. The patients in the LAMS group were more complicated (mean complexity 1.6±0.69 versus1.4±0.69; p=0.29) yet took less time (mean time in minutes 31.5 against 67.5; p< 0.01) so giving better value (0.16±0.10 versus 0.04±0.032; p< 0.0001).

    Conclusions This study adds further weight to the evidence supporting LAMS guided EUS guided endoscopic drainage of pancreatic PFCs as compared to plastic stents.