Clin Endosc > Epub ahead of print
RWON Study: The Real-World Walled-off Necrosis Study
Ankush Pawar1 , Ujjwal Sonika1 , Manish Kumar1 , Sundeep Saluja2 , Siddharth Srivastava1
1Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
2Department of Gastrosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
Correspondence :  Siddharth Srivastava ,Tel: +91-11-2323-4242 (ext. 5203), Fax: +91-11-2323-9442, Email: docsiddharth1@gmail.com
Received: June 29, 2020  Revised: October 15, 2020   Accepted: October 16, 2020
Abstract

Background/Aims:
The management of patients with walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce.
Methods:
Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage, or a combination of PCD and endoscopic drainage. We compared technical success, clinical success, mortality, readmissions, complications, and length of hospital stay among these modalities.
Results:
A total of 264 patients were evaluated (predominantly men: n=195, 74%). The mean age was 37.66 (±14.41) years. The etiology of acute pancreatitis was excessive alcohol consumption in 115 (44%) and biliary (gall stone, microlithiasis) in 89 (34%). The most common indications for drainage were pain (n=253, 96%) and fever (n=140, 53%). Of the patients, 74 (28%) were treated with medical therapy alone, 81 (31%) with endoscopic drainage, 98 (37%) with PCD, and 10 (4%) with a combined approach. Technical success and clinical success were achieved in 78 (93%) and 74 (91%) patients in the endoscopic arm and in 88 (90%) and 79 (81%) patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group.
Conclusions:
Endoscopic drainage of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.
Key Words: Drainage; Endoscopic ultrasound; Necrosis; Pancreatitis; Self-expandable metallic stent
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