S0919 AXIOS Lumen-Apposing Metal Stent in the Treatment of Peripancreatic Fluid Collections, 4-Year Retrospective Observation at a Large Care Center

INTRODUCTION: Peripancreatic fluid collections (PFCs) are one of the most common complications of acute pancreatitis. The majority of PFCs resolve spontaneously, while the rest form mature cysts filled with either necrotic debris or with fluid, classified as walled off pancreonecrosis (WOPN) and pancreatic pseudocysts (PP) respectively. Recent advancement in endoscopic procedures with the development of electrocautery enhanced AXIOS™ lumen opposing metal stents (EEAL) has primed EUS guided drainage as a treatment of choice for PFCs. METHODS: This is an IRB approved retrospective chart review of EEAL performed at a large quaternary care center. Procedural data including technical and clinical success rate were collected and analyzed. RESULTS: 38 patients underwent 51 EEAL procedures for the treatment of PFCs. WOPN was found in 70.6% and PP in 29.6% of patients respectively. 92.2% of the cysts were at least 6cm in diameter. 11 patients required multiple EEAL placements, of whom 7 patients had multiple cysts requiring separate treatments, 2 patients had a reoccurrence of the cysts requiring drainage, 1 patient required 2 EEAL placed for one large septated cyst and 1 patient required 2 attempts to place the stent. Technical success rate was 96.1%. During two procedures EEAL angulated during placement. In one patient stent dislodged to the stomach and was removed, in the second, stent was placed to the fluid surrounding the PFCs and ultimately was removed during surgery. Clinical success rate was measured by symptoms resolution at a first outpatient office visit and by cyst resolution. Only after 5 interventions (9.8%) patients didn’t experience any clinical improvement post-procedurally of which 2 required surgical intervention, 2 had cyst reoccurrence and 1 had stent placement in the pericystic area. Cyst resolution was classified as complete, incomplete (>50%) or partial (<50%). Complete cyst resolution was observed in 43.8%, incomplete in 39.6%, and partial in 16.7% of patients. The average hospital stay after EEAL placement was 7.89 days with a mean of 3.5 days. CONCLUSION: Our data demonstrate the safety and efficacy of EEAL use in the treatment of PFCs with a high technical success rate of 96.1%. Over 90% of patients experienced partial or complete resolution of their symptoms and 83.4% had at least 50% of cyst size reduction was noted. Larger studies in this area are needed to prove EEAL’s superiority over more traditional methods of treating PFCs.