Poster Session II - A317 LONG-TERM OUTCOMES OF ENDOSCOPIC DRAINAGE MODALITIES IN PATIENTS WITH PANCREATIC AND PERIPANCREATIC FLUID COLLECTIONS FOLLOWING ACUTE PANCREATITIS: AN INTERNATIONAL MULTICENTER COHORT STUD

TL;DR

This study examines long-term outcomes of endoscopic drainage for pancreatic fluid collections after acute pancreatitis, finding that complex collections and stent type affect recovery time and complications.

Contribution

The study provides new insights into long-term clinical outcomes and predictors of recovery following endoscopic drainage for pancreatic fluid collections.

Findings

LAMS/BFMS stent placement was associated with faster clinical improvement compared to other drainage methods.

Complex collections were linked to delayed improvement, lower resolution rates, and higher complication rates.

Prolonged hospitalization was a predictor of delayed clinical improvement.

Abstract

The clinical trajectory of patients with peripancreatic collections is heterogenous and long-term outcomes following endoscopic drainage remain poorly characterized.

This study aims to evaluate long-term outcomes in patients with PPFC who underwent different drainage modalities and determine independent predictors of time to clinical improvement.

Consecutive adult (age ≥ 18 years) patients with history of acute pancreatitis and radiologically confirmed PPFC who underwent endoscopic drainage were included. PPFC were categorized as simple (localized collections) or complex (extending into the paracolic space). The primary outcome was time to clinical improvement, defined as resolution of infection, biliary or gastric outlet obstruction, or pain. Secondary outcomes included predictors of clinical improvement and overall PPFC resolution.

A total of 404 patients were included in this report. The mean age was 54.18 years (SD 15.3), 68.81% were male and 254 (62.9%) had complex collections. LAMS or BFMS placement was associated with a faster time to improvement (HR = 1.95, 95% CI: 1.32-2.90, p = 0.001), whereas complex collections (HR = 0.30, 95% CI: 0.21-0.44, p < 0.001) and prolonged hospitalization (HR = 0.99, 95% CI: 0.98-0.99, p < 0.001) were predictors of delayed clinical improvement. In comparison with patients with simple collections, those with complex collections had lower collection resolution rates (68.62% vs. 88.41%, p < 0.001) as well as higher rates of readmission (median of 3 [IQR: 0–5]) vs 3 [IQR: 0–3], p = 0.03), multiorgan failure (15.8% vs 1.3%, p < 0.001), and portal vein thrombosis (7.1% vs. 2.0%, p = 0.02).

Patients with complex collections, extending into the paracolic space, had prolonged recovery and increased intervention requirements. In these patients, metal stent (LAMS or BFMS) placement significantly accelerated clinical improvement. Further research is needed to refine management strategies for these high-risk patients.

A317 Table 1: Results of Cox Proportional Hazards Regression Analysis for Time to Clinical Improvement

Significance (*) is indicated by p < 0.05; PS: propensity score to receive a LAMS/BFMS for drainage.

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