S75 Safety and Efficacy of Endoscopic Drainage of Pancreatic Fluid Collections Performed by Early Career Advanced Endoscopists: A Multicenter Experience

Introduction: Over the past decade, endoscopic ultrasound (EUS) guided drainage has become the gold standard in management of symptomatic pancreatic fluid collections (PFCs). While there are ample data showing the safety and efficacy of endoscopic drainage of PFCs, these data are largely derived from expert advanced endoscopists. Comparatively, there is little published on outcomes of endoscopic drainage of PFCs performed by early career advanced endoscopists. We aimed to evaluate the safety and efficacy of endoscopic drainage of PFCs performed by early career advanced endoscopists. Methods: This was a multicenter, retrospective analysis of all patients who underwent EUS-guided drainage of PFCs, performed by 6 early career advanced endoscopists (defined as within 2 years of graduating advanced endoscopy fellowship). Patient and procedure characteristics were recorded. Procedure characteristics included type and location of collection, type and size of stent placed and location of stent placement. Primary outcomes were technical and clinical success. Other outcomes included adverse events and procedure-related mortality. Results: A total of 24 patients underwent endoscopic drainage of PFCs. The mean age was 53 years and 21% were female [Table]. Median duration of follow-up was 90 days. Three patients (12.5%) were anticoagulated. The average Charlson Comorbidity Index was 2.3. The collections included pseudocysts (37.5%%), walled-off necrosis (45.8%) and post-surgical collections (16.7%). The location was peripancreatic in 10 cases (41.7%) and pancreatic in 14 cases (58.3%). The PFC drainage approach was transgastric in 22 cases (91.7%) and transduodenal in 2 cases (8.3%). The primary drainage modality was lumen-apposing metal stents (LAMS) in 21 cases (87.5%) and plastic stents in 3 cases (12.5%). Clinical success was achieved in 22 cases (91.7%) and technical success in 23 cases (95.8%). The only adverse event was LAMS maldeployment in 1 case (8%), which was immediately removed and the defect closed with an over-the-scope clip without immediate or delayed bleeding or perforation. One patient (8%) had delayed bleeding during subsequent necrosectomy and underwent angioembolization by interventional radiology. There was no procedure-related mortality during the study period. Conclusion: We found that endoscopic drainage of pancreatic fluid collections is safe and effective in the hands of early career advanced endoscopists, with outcomes comparable to those reported by later career endoscopists. Table 1. - Patient and procedure characteristics n = 24 Patient characteristics Age, years 53 (SD 14) Female 5 (21%) Inpatient 9 (56%) Platelets (K/cmm) 298 INR 1.13 Any anticoagulation 3 (12.5%) Argatroban 1 (4.2%) Apixaban 1 (4.2%) Warfarin 1 (4.2%) Charlson Comorbidity Index, average 2.6 Collection Type Pseudocyst 9 (37.5%) Walled-off necrosis 11 (45.8%) Post-surgical collection 4 (16.7%) Collection Location Peripancreatic 10 (41.7%) Pancreatic 14 (58.3%) Head 2 Body/Tail 9 Entire pancreas 3 Procedure characteristics Site of EUS Pancreatic Drainage Stomach 22 (91.7%) Duodenum 2 (8.3%) Native Anatomy 23 (95.8%) Stent used LAMS 21 (87.5%) Plastic 3 (12.5%) LAMS Size 10 mm x 10 mm 2 (9.5%) 15 mm x 10 mm 14 (66.7%) 20 mm x 10 mm 5 (23.8%) Clinical Success 22 (91.7%) Technical Success 23 (95.8%) Adverse events LAMS maldeployment 1 (4.2%) Bleeding 0 Stent migration 0 Post-procedural pain within 30-days 3 (12.5%) Need for admission within 30-days 7 (29.2%) Death within 30-days 0 Stent removed 19 (79.2%) Mean time until stent removed, days, SD 27 (SD 22) Mean number of GI interventions 1.6 Duration of follow-up median, days 90