RWON Study: The Real-World Walled-off Necrosis Study

Pawar, Ankush; Sonika, Ujjwal; Kumar, Manish; Saluja, Sundeep; Srivastava, Siddharth

doi:.0.0.0

Clin Endosc > Epub ahead of print

Original Article

RWON Study: The Real-World Walled-off Necrosis Study

, 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