P-THER-17: Are plastic stents good enough for walled-off necrosis drainage? A retrospective analysis of 162 patients over the last 7 years

OBJECTIVES: To retrospectively analyze 162 cases of walled-off necrosis (WON) treated with only plastic stents in a tertiary referral center in India. METHODS AND RESULTS: A total of 162 patients of WON underwent endoscopic ultrasound (EUS)-guided drainage with a 19-gauge needle puncture, tract formation with 6 Fr cystotome, dilatation with controlled radial expansion balloon up to 12 mm, placement of two 7 Fr disposable pressure transducer stents, and nasocystic drain. Drain was removed after 48 h, and necrosectomy was done as per the need in 3–5 sessions 48 h apart. Total number of patients was 162; size of the WON was 10.2 cm (6–30 cm); amount of necrosis was 37% (7%–63%); primary procedure was carried out in 24.3 min (17–60 min), first session - 31.6 min (20–55 min), second session - 22.5 min (12–35 min), third session - 14.7 min (10–25 min), fourth session - 12.3 min (7–20 min); technical success of primary procedure was 98.1% (three procedures abandoned). Nasocystic drain - 97 patients (59.8%), necrosectomy– first session - 65 patients (40.1%), necrosectomy–second session - 57 patients (35.1%), necrosectomy–third session - 38 patients (23.4%), necrosectomy–fourth session - five patients (3.1%), bleeding - five cases (three abandoned, two controlled endoscopically), capnoperitoneum - one cases (conservative treatment). Significant infection was seen in seven cases (4.3%), minor 15 cases (9.2%), mortality - 0 cost of plastic stents (2) 35$ in India cost of Nagi Stent 850$ in India. CONCLUSIONS: Plastic stents are very effective in WON drainage with achieving clearance in around three sessions and minimal infection. Nasocystic drain helps reduce rate of infection. The procedure is very cost-effective.