P2742 - Outcomes for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections in Patients With and Without Cirrhosis in a Propensity-Matched National Cohort

Krishan S. Patel, MD, Indira Bhavsar-Burke, MD, MHPE
University of Texas Southwestern Medical Center, Dallas, TX

Introduction: Pancreatic fluid collections (PFC) and walled-off-necrosis are late complications of acute pancreatitis. Endoscopic ultrasound (EUS) guided drainage is a minimally invasive strategy that represents an attractive option for patients with increased comorbidities who are less optimal surgical candidates. Prior research suggests increased risk of complications in patients with cirrhosis. This study aims to further characterize outcomes related to endoscopic drainage in patients with cirrhosis in a large national cohort.

Methods: The United States national collaborative network was accessed via TriNetX platform, and ICD-10 and CPT codes were used to identify patients >18 years of age with and without cirrhosis who underwent EUS guided drainage of PFC. Standard 1:1 propensity matching was used for age, race, sex, thrombocytopenia, diabetes, lung disease, malnutrition, alcohol and nicotine use, chronic kidney disease, heart failure, and hypertension. Outcomes were assessed over a 30-day follow-up period and included death, intensive care admission, shock, blood transfusion, stent malfunction, vascular embolization, and surgical intervention.

Results: A total of 587 with cirrhosis and 5,357 without cirrhosis who underwent EUS guided drainage were identified. After matching, 577 patients were included in each group. Patients were primarily white (73%) and male (64%) and had a mean age of 52 years. Patients with cirrhosis had increased baseline prevalence of alcohol and nicotine use, depression, and malnutrition. Patients with cirrhosis had an increased odds ratio (OR) of death 1.76 (95% CI 1.08–2.93), shock 1.38 (95% CI 1.05–1.98), and blood transfusion 1.48 (95% CI 1.03–2.26) against matched cohorts (Table 1). There was a trend towards increased risk of intensive care admission however this did not reach significance. No difference in rates of stent complications or surgical or interventional radiology intervention were apparent.

Discussion: While EUS guided drainage represents an effective option for management of PFC, these results suggest that patients with cirrhosis have an increased risk of 30-day mortality, shock, and need for blood transfusion. Extra caution should be exercised for patients with cirrhosis to reduce post procedural decompensation. Further studies are warranted to understand how to optimize medical and endoscopic therapy to improve patient outcomes.


Disclosures:


Krishan S. Patel, MD, Indira Bhavsar-Burke, MD, MHPE. P2742 - Outcomes for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections in Patients With and Without Cirrhosis in a Propensity-Matched National Cohort, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.