Su1704 Implication of Secretin Endoscopic Pancreas Function Test for Patient Undergoing Autologous Islet Transplantation for Chronic Pancreatitis

Su1703 Endoscopic Report Card of a 10-Year Experience in 100 Patients With Walled-off Pancreatic Necrosis Ji Young Bang*, C. Mel Wilcox, John D. Christein, Muhammad Hasan, Pablo J. Arnoletti, Sebastian De La Fuente, Robert Hawes, Shyam Varadarajulu Center for Interventional Endoscopy, Florida Hospital, Orlando, FL; Gastroenterology-Hepatology, University of Alabama, Birmingham, AL; Surgery, Florida Hospital, Orlando, FL; Surgery, University of Alabama, Birmingham, AL Background: Given the high morbidity and procedure-related risks, endoscopic management of walled-off pancreatic necrosis (WOPN) remains a therapeutic challenge. Aim: To evaluate the clinical outcomes of 100 consecutive patients undergoing endoscopic management of WOPN over a 10-year period. Methods: This is a retrospective study of 100 patients (Median age 53 yrs, Male 63%) with WOPN treated endoscopically over 10 years from 2004-2013. During the initial period (20042009), pancreatitis was categorized using the 1992 Atlanta classification, access to WOPN was first attempted by conventional transmural drainage (CTD) with EUS being reserved only for failed cases and predominant treatment was by placement of transluminal stent and drainage catheters or necrosectomy. In the later period (2010-2013), pancreatitis was categorized using the (proposed) revised Atlanta classification, access was mainly under EUS-guidance and treatment approach was more HYBRID. The HYBRID approach involves endoscopic creation of multiple internal conduits for improved drainage of necrotic contents and multidisciplinary collaboration with interventional radiologists for percutaneous placement of largebore drainage catheters and pancreatic surgeons for minimally invasive percutaneous debridement. To track outcomes in relation to time, patients were divided into two groups: Group IZ2004-2009 vs. Group IIZ2010-2013. Main outcome measures: To compare clinical outcomes between two time periods (groups) and identify predictors of treatment success in patients undergoing endoscopic management of WOPN. Treatment success was defined as resolution of WOPN without the need for open surgical necrosectomy and discharge from the hospital with favorable clinical evolution. Results: There was no significant difference in pretreatment clinical parameters or WOPN characteristics between group I (NZ47) and group II (NZ53) patients. When compared to group I, patients in group II underwent more EUS-guided drainage (63.8 vs. 96.2%, p!0.001), received more HYBRID treatment (10.6 vs. 43.4%, p!0.001) and had higher treatment success (59.6% vs. 90.6%, p!0.001). On multivariate logistic regression analysis, undertaking treatment via HYBRID approach (OR 5.72, 95% CIZ 1.25-26.2; pZ0.025) was the only factor predictive of treatment success (Figure) when adjusted for the patient/disease characteristics, size/location of WOPN, access modality (EUS vs. CTD), enteral nutrition, number of endoscopic interventions and placement of transpapillary pancreatic duct stent. Conclusions: There has been an incremental improvement in the clinical outcomes of patients with WOPN managed by endoscopy over the past 10 years with a HYBRID multidisciplinary approach being the major determinant of treatment success.