Background and Aim:
Direct endoscopic necrosectomy (DEN) is frequently required in patients with walled-off pancreatic necrosis (pWON) undergoing endoscopic cystogastrostomy (ECG) with lumen-apposing metal stents (LAMS) with benefits of early source-control, higher clinical resolution and lower new-onset organ failure rates. Early identification of clinical and biochemical predictors may optimise patient selection and procedural planning. We aimed to identify predictors of DEN among patients undergoing LAMSdrainage for pWON.
Methods:
Retrospective analysis of individual patient-data who underwent LAMS placement for pWON at tertiary centre from January 1,2020 to December 31, 2024. Patients were grouped as DEN+ (those requiring DEN) and DEN- (no necrosectomy). Clinical, radiological, and laboratory parameters were compared using univariate analysisand p-value <0.05 was considered statistically significant.
Results:
215 patients underwent LAMS-guided drainage, 83 (38.6%) required DEN. On univariate analysis, DEN+ patients were older (37.91+13.69 vs 33.79+13.41 years, p = 0.031), had frequent ascites (18.1% vs 7.8%, p = 0.019) and fever (59% vs. 42.4%, p = 0.002) at presentation. Serum albumin was significantly lower in DEN+ patients (3.24+0.69 vs. 3.44+0.76 g/dL, p = 0.047). Gender, diagnosis (acute pancreatitis vs. acute-on-chronic), collection size, location, comorbidity profile, timingof drainage, and haematological parameters were not significantly different. The presence of disconnected pancreatic duct syndrome (DPDS) trended towards significance (p = 0.054).
Conclusion:
In patients undergoing endoscopic cystogastrostomy for pancreatic necrosis, older age, presence of ascites, fever, and hypoalbuminemia are significant predictors of need for DEN. These findings may help stratify risk earlier and guide for upfront necrosectomy for better results.