Direct Endoscopic Necrosectomy With Lumen Apposing Metal Stents for Pancreatic Walled Off Necrosis

Abstract

Direct endoscopic necrosectomy (DEN) with lumen-apposing metal stents (LAMS) is increasingly used in the management of pancreatic walled-off necrosis (WON). Early identification of high-risk patients irresponsive to DEN with LAMS will facilitate closer postoperative surveillance and optimal clinical decision-making. However, the prediction study on successful DEN with LAMS for pancreatic WON is lacking. Meantime, there has been a global trend to perform endoscopic interventions on an outpatient basis, which has advantages of convenience, efficiency, economy, and satisfaction. Now most patients undergoing DEN with LAMS for WON are hospitalized due to perceived increased risk of adverse events. Whether outpatient DEN with LAMs is safe and feasible, and which patients could be performed in an outpatient setting remain unknown. In this project, we retrospectively reviewed and analyzed a prospectively maintained database, including 101 consecutive patients who underwent DEN with LAMS since the year (2014) LAMS arrived on the market. First, we explore predictors of successful DEN with LAMS for pancreatic WON. Second, we evaluate the feasibility of outpatient DEN with LAMS, and compare the safety and efficacy on an outpatient versus inpatient basis among a case-matched cohort. This project provided a relatively large cohort of patients with WON who exclusively underwent DEN with the novel LAMS. To the best of our knowledge, this is the first prediction study for successful DEN with LAMS, and the first comparative study of DEN with LAMS on outpatient versus inpatient basis. The project will facilitate clinical decision-making and prognostication prior to DEN, and provide a good reference to proper selection criteria for outpatient DEN.