Pancreatic Walled-Off Necrosis: Cross-Sectional Imaging Depiction of Debris Predicts the Success of Endoscopic Drainage Using Lumen Apposing Metal Stents.

Abstract

BACKGROUND The use of endoscopic ultrasound-guided (EUS) transmural stent placement for pancreatic walled-off-necrosis (WON) drainage is widespread. This study retrospectively analyzes imaging parameters predicting the outcomes of WON endoscopic drainage using lumen apposing metal stents (LAMS). METHODS The study analyzed data of 115 patients who underwent EUS-guided debridement using LAMS from 2011 to 2015. Pre-intervention CT or MRI were used to analyze WON total volume, percentage of debris, multilocularity, and density. Success measures included technical success, the number of endoscopic sessions, requirement of percutaneous drainage, long-term success, and recurrence. RESULTS The primary cause of pancreatitis was gallstones (50.4%), followed by alcohol (27.8%), hypertriglyceridemia (11.3%), idiopathic (8.7%), and autoimmune (1.7%). The mean WON size was 674 mL. All patients underwent endoscopic necrosectomies, averaging 3.1 sessions. Stent placement was successful in 96.5% of cases. Procedural complications were observed in 13 patients (11.3%) and six patients (5.2%) needed additional percutaneous drainage. No patients reported recurrent WON post-treatment. Univariate analysis indicated a significant correlation between debris percentage and the need for additional drainage and long-term success (p <0.001). The number of endoscopic sessions correlated significantly with debris percentage (p < 0.001). CONCLUSIONS Preprocedural imaging, particularly debris percentage within WON, significantly predicts the number of endoscopic sessions, the need for further percutaneous drainage, and overall long-term success.