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Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study

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Abstract

Background

Necrotizing pancreatitis can be complicated by Necrotic Fluid Collections (NFC). Guidelines recommend waiting for 4 weeks from the onset of acute pancreatitis (AP) before considering endoscopic drainage. We aimed to compare outcomes and safety in patients undergoing early versus late drainage of NFC.

Methods

We performed a retrospective review of all patients who underwent Dual Modality Drainage (DMD) [combined endoscopic and percutaneous drainage] for NFC from January 2007 to December 2020. Patients were stratified into the “early” group (DMD < 28 days from AP onset) and were matched to “late” (DMD ≥ 28 days) drainage group using propensity- core-matching. Primary outcomes of interest were technical success and adverse events. Secondary outcomes included clinical success, late complication rates, and mortality.

Results

We identified 278 patients who underwent DMD for NFC. Thirty-nine belonged to the early group and were matched to 174 patients from the late group. Technical success was similar in both early and late groups (97.4% vs 99.4%: P = 0.244) as were the procedural and early post-procedural (< 14 days) adverse events rates (23.1% vs 27.6%: P = 0.565). Clinical success (92.3% vs 93.1%; P = 0.861) and late complication rates (23.1% vs 31.6%; P = 0.294) were similar. There were 2 deaths (5.7%) in the early vs. 9 (5.2%) in the late group, P = 0.991.

Conclusions

When performed in a tertiary care center with expertise in therapeutic endoscopic ultrasound, early drainage of NFC appears to be feasible and safe. Further studies are needed to validate our results.

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Acknowledgements

Authors acknowledge Terri Davis Smith for providing editing/formatting and administrative support in the production of this manuscript.

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Authors and Affiliations

  1. Center for Digestive Health, Virginia Mason Franciscan Health, 1100, 9th Avenue, Mail stop: C3-GAS, Seattle, WA, 98101, USA

    Shivanand Bomman, David Sanders, David Coy, Danielle La Selva, Quincy Pham, Troy Zehr, Joanna Law, Michael Larsen, Shayan Irani, Richard A. Kozarek, Andrew Ross & Rajesh Krishnamoorthi

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  1. Shivanand Bomman
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Correspondence to Rajesh Krishnamoorthi.

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Disclosures

Dr. David Coy is a consultant to MCG Health as a reviewer of evidence-based guidelines for diagnostic imaging. Dr. Shayan Irani is a consultant for Boston Scientific and Gore. Dr. Richard A. Kozarek receives research support from Boston Scientific. Dr. Andrew Ross is a consultant for Boston Scientific. Dr. Shivanand Bomman, Dr. David Sanders, Danielle La Selva, Dr. Quincy Pham, Troy Zehr, Dr. Joanna Law, Dr. Michael Larsen, and Dr. Rajesh Krishnamoorthi have no conflicts of interest or financial ties to disclose.

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Bomman, S., Sanders, D., Coy, D. et al. Safety and clinical outcomes of early dual modality drainage (< 28 days) compared to later drainage of pancreatic necrotic fluid collections: a propensity score-matched study. Surg Endosc 37, 902–911 (2023). https://doi.org/10.1007/s00464-022-09561-8

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