REGULAR CONTENT
Final ID
519
Type
Original Scientific Research-Poster Only
Authors
Z Li1, D Mitchell2, A Siddiqui2
Institutions
1Thomas Jefferson University Hospital, Philadelphia, PA, 2Thomas Jefferson University, Philadelphia, PA
Purpose
Endoscopic ultrasound-guided (EUS) transgastric stent placement has been widely adopted for draining pancreatic walled-off-necrosis (WON). The aim of this retrospective study was to investigate clinical and imaging parameters that may predict outcomes of endoscopic drainage of WON using AXIOS stents.
Materials & Methods
A retrospective search for patients with WON who underwent EUS-guided debridement using AXIOS stents (10-15 mm) in a single academic center from 2010 to 2015 yielded 115 patients. Total volume (TV), percentage of debris (D), multilocularity (L) and overall attenuation of WON (OA) were analyzed on either CT or MRI (n = 101 and 14, respectively) within 1 week prior to intervention. Outcomes were measured by technical success (ability to access and drain a WON by placement of transmural stents), number of endoscopic sessions (NES) to achieve WON resolution, need for additional percutaneous drainage (PD), and long-term success.
Results
Of 115 patients, the etiology of pancreatitis was gallstones (50.4%), alcohol (27.8%), hypertriglyceridemia (11.3%) and other (10.4%). The mean WON size was 674 mL. The mean NES was 3.05 (range: 1-7). The technical success rate of stent placement was 96.5%. Six patients (5.2%) required subsequent PD. None of the patients had recurrence after treatment. In univariate analysis, D within WON is a significant predictor of the need for additional PD and long-term success (p <0.001) while TV, L and OA of WON are not predictive. Spearman correlation showed significant correlation between D and NES needed to achieve WON resolution (p < 001, ρ= 0.637). NES needed was significantly lower in WONs with less internal debris (1.3, 0%; 2.6, 1-10%; 4.0, 11-20%; 3.7, 21-30%; 3.7, 31-40%; 4.4, >40%) in One-way ANOVA (p < 0.001). A predictive model using a cutoff value of 36.7% internal debris within WON achieved 100% sensitivity, 91.7% specificity and an area under the curve of 0.972 (ROC analysis) in identifying patients who needed additional PD.
Conclusions
Percentage of internal debris within WON on preprocedural imaging is a significant predictor of number endoscopic sessions needed, the need for additional percutaneous drainage and overall long-term success.
Final ID
519
Type
Original Scientific Research-Poster Only
Authors
Z Li1, D Mitchell2, A Siddiqui2
Institutions
1Thomas Jefferson University Hospital, Philadelphia, PA, 2Thomas Jefferson University, Philadelphia, PA
Purpose
Endoscopic ultrasound-guided (EUS) transgastric stent placement has been widely adopted for draining pancreatic walled-off-necrosis (WON). The aim of this retrospective study was to investigate clinical and imaging parameters that may predict outcomes of endoscopic drainage of WON using AXIOS stents.
Materials & Methods
A retrospective search for patients with WON who underwent EUS-guided debridement using AXIOS stents (10-15 mm) in a single academic center from 2010 to 2015 yielded 115 patients. Total volume (TV), percentage of debris (D), multilocularity (L) and overall attenuation of WON (OA) were analyzed on either CT or MRI (n = 101 and 14, respectively) within 1 week prior to intervention. Outcomes were measured by technical success (ability to access and drain a WON by placement of transmural stents), number of endoscopic sessions (NES) to achieve WON resolution, need for additional percutaneous drainage (PD), and long-term success.
Results
Of 115 patients, the etiology of pancreatitis was gallstones (50.4%), alcohol (27.8%), hypertriglyceridemia (11.3%) and other (10.4%). The mean WON size was 674 mL. The mean NES was 3.05 (range: 1-7). The technical success rate of stent placement was 96.5%. Six patients (5.2%) required subsequent PD. None of the patients had recurrence after treatment. In univariate analysis, D within WON is a significant predictor of the need for additional PD and long-term success (p <0.001) while TV, L and OA of WON are not predictive. Spearman correlation showed significant correlation between D and NES needed to achieve WON resolution (p < 001, ρ= 0.637). NES needed was significantly lower in WONs with less internal debris (1.3, 0%; 2.6, 1-10%; 4.0, 11-20%; 3.7, 21-30%; 3.7, 31-40%; 4.4, >40%) in One-way ANOVA (p < 0.001). A predictive model using a cutoff value of 36.7% internal debris within WON achieved 100% sensitivity, 91.7% specificity and an area under the curve of 0.972 (ROC analysis) in identifying patients who needed additional PD.
Conclusions
Percentage of internal debris within WON on preprocedural imaging is a significant predictor of number endoscopic sessions needed, the need for additional percutaneous drainage and overall long-term success.