S3234 The Outcomes and Adverse Events After EUS-Guided Drainage of Peripancreatic Fluid Collections With the Use of Lumen Apposing Metal Stents

INTRODUCTION: Peripancreatic fluid collections (PFCs) are known complications of acute pancreatitis. The majority of PFCs reabsorb within the first several weeks, while the remainder mature and create a walled cyst filled with fluid (pancreatic pseudocysts, PP) or necrotic debris (walled off pancreonecrosis, WOPN). EUS guided drainage of PFCs with the use of lumen apposing metal stents (LAMS) is currently considered to be safe first line therapy of PFCs. Recently, electrocautery enhanced AXIOS LAMS (EEAL) has been developed to provide faster and safer stent placement. Our study aimed to demonstrate safety and efficacy data regarding this new technique. METHODS: This is an IRB approved retrospective chart review of EEAL performed at a large quaternary teaching hospital. Procedural data including the etiology of PFCs, adverse events, repeated interventions were collected. RESULTS: 38 patients underwent 51 EEAL procedures for the treatment of PFCs. PFCs consisted of WOPN in 70.6% and PP in 29.6% of patients. Adverse events were noted in 11 patients (21.6%). Minor bleeding occurred in 7.8% of cases and resolved spontaneously (1.96%) or required cauterization (3.92%) or local epinephrine irrigation (1.96%). 4 EEAL procedures resulted in stent migration to the stomach. Despite this, 2 of those cases resulted in the cysts and symptoms resolution, 1 (1.96%) required to repeat EEAL and in the final case, the PFCs were ultimately drained with a plastic stent. In 1 case, the EEAL was supported by plastic stent which unfortunately became obstructed resulting in repeat procedure. Major complication occurred in 2 patients of whom one developed pseudoaneurysm requiring coil embolization and the second suffered stent angulation and placement into the pericystic cavity resulting in infection and surgical intervention. Washouts were performed in 34 PFCs (range: 1-9, mean 2.7) and necrosectomies were performed in 19 PFCs (range: 1-6, mean 2.5). The average time to stent removal was 24.85 days with a mean of 19 days. CONCLUSION: Data regarding adverse events and efficacy of EEAL is still inadequate. We observed complications in nearly 22% of procedures performed, mostly limited to minor bleeding or stent migrations. Ultimately, larger studies will need to be done to determine the degree of benefit of EEAL, however, our data preliminarily demonstrates a notable degree of efficacy and safety.