Thomas Jefferson University Hospital Philadelphia, PA
Jacqueline Krieger, MD1, Tina Boortalary, MD1, Michel Kahaleh, MD2, Amy Tyberg, MD2, Haroon Shahid, MD2, Avik Sarkar, MD2, Iman Andalib, MD2, Harneet Sangha, BS3, Mohit Girotra, MD4, Kinnari Modi, DO5, Hassan Allahrakha, DO5, Paul Tarnasky, MD5, Prashant Kedia, MD5, Rishi Pawa, MD6, Swati Pawa, MD7, Afshin Khan, MD, MPH8, Donna Leet, MD8, Abdul Kouanda, MD8, Alexander Schlachterman, MD9, Alana Persaud, MD9, Yasi Xiao, MD9, Anand Kumar, MD, MPH1, Faisal Kamal, MD9, Thomas Kowalski, MD9 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Hackensack Meridian Health, Hackensack, NJ; 3Washington State University Elson S. Floyd School of Medicine, Spokane, WA; 4Swedish First Hill Medical, Seattle, WA; 5Methodist Dallas Medical Center, Dallas, TX; 6Atrium Health Wake Forest Baptist, Winston-Salem, NC; 7Atrium Health Wake Forest Baptist,, Winston-Salem, NC; 8University of California San Francisco, San Francisco, CA; 9Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA Introduction: In patients with complex walled-off necrosis (WON), a percutaneous drain placed by interventional radiology (IR) may be combined with cystgastrostomy for WON management. The management and outcomes of patients with both IR drain and cystgastrostomy for WON management have not been well studied. The purpose of this study is to investigate time to resolution of WON in patients with various strategies of dual therapy. Methods: A multi-centered, retrospective chart review was conducted at 6 tertiary medical centers in the US. Patients were included if they had WON managed with both cystgastrostomy and an IR drain. WON resolution was defined when all stents and drains had been removed. Data was collected on the size and location of WON, and the timing of IR drains, lumen apposing metal stents (LAMS), and double pigtail stents (DPS). The area of the WON was calculated using a formula for an oval with two of the largest recorded dimensions on imaging. Results: A total of 76 patients underwent both IR drainage and cystgastrostomy for WON. 39 patients were excluded because the IR drain and cystgastrostomy were not within a contiguous collection. Of the 37 remaining, the etiology of pancreatitis was most commonly gallstones (43%) and alcohol (38%). Data regarding the location and size of the WON, number of necrosectomies, and timing of IR drain and cystgastrostomy are demonstrated in Table 1. IR drain was placed first in 32.4% of patients, LAMS first in 62.2%, and both on the same day in 5.4%. The IR drain was removed first in 54% of patients, LAMS first in 46%. In patients who had IR drains placed first, the average time to WON resolution was 160 +/- 93 days compared to 137 days +/-131 for those who had a LAMS placed first (P=0.598). In patients who had the IR drain removed first, the time to WON resolution was 147 +/- 138 compared to 136 +/- 89 for those who had LAMS removed first (p=0.796). In this cohort, the total days from LAMS deployment to LAMS removal were over two-thirds (77.9%) of the total WON treatment time. Discussion: Walled-off necrosis encompasses diverse cases where various treatment algorithms are employed, tailored to specific clinical and anatomical circumstances. In the treatment of complex WON, it remains unclear whether a combined treatment strategy may hasten, or delay WON resolution. This study did not reveal treatment approaches that statistically demonstrated superior outcomes. Prospective studies are needed to determine the most effective combined strategies.
Figure: Table 1: Description of WON morphology and IR and cystgastrostomy time intervals
Disclosures: Jacqueline Krieger indicated no relevant financial relationships. Tina Boortalary indicated no relevant financial relationships. Michel Kahaleh: Boston Scientific – Consultant, Grant/Research Support. Cook Medical – Grant/Research Support. Creo – Consultant, Grant/Research Support. Erbe – Consultant, Grant/Research Support. Fuji – Grant/Research Support. Medtronic – Consultant, Grant/Research Support. Microtech – Consultant, Grant/Research Support. Olympus – Consultant, Grant/Research Support. Pentax – Grant/Research Support. Amy Tyberg: Ambu – Consultant. Boston Scientific – Consultant. Medtronic – Consultant. Haroon Shahid indicated no relevant financial relationships. Avik Sarkar indicated no relevant financial relationships. Iman Andalib indicated no relevant financial relationships. Harneet Sangha indicated no relevant financial relationships. Mohit Girotra indicated no relevant financial relationships. Kinnari Modi indicated no relevant financial relationships. Hassan Allahrakha indicated no relevant financial relationships. Paul Tarnasky indicated no relevant financial relationships. Prashant Kedia: Boston Scientific – Consultant. Olympus – Consultant. Rishi Pawa indicated no relevant financial relationships. Swati Pawa: Boston Scientific – Consultant. Afshin Khan indicated no relevant financial relationships. Donna Leet: Neptune Medical – Consultant. Abdul Kouanda indicated no relevant financial relationships. Alexander Schlachterman: Boston Scientific – Consultant. FujiFilm – Consultant. Laborie – Consultant. Lumendi – Consultant. Microtech – Consultant. Olympus – Consultant. Alana Persaud indicated no relevant financial relationships. Yasi Xiao indicated no relevant financial relationships. Anand Kumar: Boston Scientific – Consultant. Olympus – Consultant. Pentax – Paid Speaker. Faisal Kamal indicated no relevant financial relationships. Thomas Kowalski: Boston Scientific – Consultant.
Jacqueline Krieger, MD1, Tina Boortalary, MD1, Michel Kahaleh, MD2, Amy Tyberg, MD2, Haroon Shahid, MD2, Avik Sarkar, MD2, Iman Andalib, MD2, Harneet Sangha, BS3, Mohit Girotra, MD4, Kinnari Modi, DO5, Hassan Allahrakha, DO5, Paul Tarnasky, MD5, Prashant Kedia, MD5, Rishi Pawa, MD6, Swati Pawa, MD7, Afshin Khan, MD, MPH8, Donna Leet, MD8, Abdul Kouanda, MD8, Alexander Schlachterman, MD9, Alana Persaud, MD9, Yasi Xiao, MD9, Anand Kumar, MD, MPH1, Faisal Kamal, MD9, Thomas Kowalski, MD9. P5651 - Outcomes and Time to Resolution in Combined Endoscopic and Percutaneous Drainage of Walled-Off Necrosis in Necrotizing Pancreatitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
