Su1716 Outcomes in Main Pancreatic Duct Endoscopic Drainage for Pain Relief in Patients With Chronic Pancreatitis: a Multicenter Experience

academic (63.4%) hospitals. Mean hospital charges were $26,412 (S.E.M. $981). Mean length of stay was eight days (S.E.M. 0.2) with in-hospital mortality of 0.93%. Over the study period, the number of procedures has decreased significantly (p! 0.001) (Figure 1). Conclusions: In the United States, ERCP has been an important diagnostic and therapeutic tool for chronic pancreatitis. Over the last 12 years, ERCP has become an uncommon inpatient procedure for chronic pancreatitis. Su1716 Outcomes in Main Pancreatic Duct Endoscopic Drainage for Pain Relief in Patients With Chronic Pancreatitis: a Multicenter Experience Ali Siddiqui*, Elizabeth Ssebayigga, Harkirat Singh, Jonathan Gotfried, Thomas E. Kowalski, David E. Loren, Oleh Haluszka, Jennifer L. Maranki Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA; Gastroenterology, Temple University, philadelphia, PA Background: In patients with chronic pancreatitis (CP), pancreatic ductal obstruction due to a stricture can increase pressure within the duct and contribute to symptoms of chronic pain. There is currently a paucity of data regarding endoscopic pancreatic stent drainage as an alternative to surgery for pain relief in these patients. Aim: The aim of this study was to evaluate the outcomes of endotherapy (ET) with pancreatic stent drainage for pain relief in patients with chronic pancreatitis with a dominant pancreatic duct stricture or dilated duct. Methods: A retrospective review of patients with abdominal pain due to CP and main pancreatic duct stricture or ductal dilation who underwent an endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic stent was performed at 2 academic, tertiary care centers. Patient demographics, technical success (successful stent placement across the stricture), procedural complications, and duration of follow-up were noted. The primary outcome was pain relief (partial or complete) with endotherapy at the end of the follow-up period. Secondary outcomes were cessation of narcotic therapy after stent placement, number of procedures undergone for stent management, and number of patients who needed operative drainage. Disease progression was followed up from its onset until August 2013. Descriptive statistics as well as chi square analyses were performed using SPSS v 20. Results: We analyzed a total of 92 patients [58 males, median age 56 1.7(SE) years]. The etiologies of chronic pancreatitis were predominantly due to alcohol (45, 48.9%). Patients were followed for a median of 9 months. ET with stricture dilation (64% of patients) and stent placement (97% of patients) was technically successful in all patients in whom it was attempted. Patients underwent a median of 3 procedures (range 1 16). Sixty-nine (75%) reported complete (nZ47) or partial pain (nZ22) relief with endotherapy. 30/63 (47.6%) patients were able to decrease their narcotic use after ET. Patients who had decreased pain after ET were older (R50 years) and more likely to be male than patients who did not respond to ET (p!0.05). There were no differences of pain relief after ET according to the diameter of stent, methods of stricture dilatation, or duration of stenting. Twenty-one (23%) patients underwent surgery for significant abdominal pain that did not respond to ET. Conclusions: Pancreatic duct stenting results in an improvement in three-fourths of patients who had abdominal pain as a result of chronic pancreatitis, with reductions in narcotic dosage in almost half of patients. Patients who were older and male were more likely to respond to endotherapy. AB378 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 Su1717 Prototype Stent Design With Sof-Flex Material and Ampullary Retention Flap for Pancreatic Endotherapy Brian C. Brauer*, Raj J. Shah Medicine, Univ of Colorado, Aurora, CO Background: Chronic pancreatitis (CP) pain may be related to pancreatic duct (PD) obstruction with increased intraductal pressures. Transpapillary stenting may decompress the PD and afford pain relief. Current polyethylene PD stents with intraductal internal flaps may lead to stent-induced stricture (SIS). A softer stent material and an internal flap just upstream of the ampulla (ampullary retention flap) may reduce SIS. However, its ability to traverse or resolve tight strictures is unknown. Technical success, retention, and occlusion rates of the Anchora Sof-Flex (ASF; 8.5F and 10F; Cook Medical) stent with an external pigtail and an ampullary retention flap were evaluated. Methods: The ASF consists of an introducer (Oasis, Cook) advanced beyond the stent tip to stiffen the device (see Figure). Following guidewire advancement across the target stenosis, the ASF was inserted. Technical successZbridging target stenosis. Clinical endpoints: 1) Retention, 2)Patency by visual inspection: patentZfree flow of pancreatic fluid, partial occlusionZencrustation with fluid flow maintained, complete occlusionZno flow of fluid, 3) SIS in the PD. Results: Between 3/2011 and 4/2013, 58 pts (39 F, mean age 47 18) underwent 76 ERCP’s with 79 ASF insertions for CP PD stricture. Technical success was achieved in 76/79 (95%) insertions. In 2 failures the stent was unsuccessful in traversing a tight stricture and in one case introducer fracture was noted and retrieved; insertion of a new stent with a new introducer was successful. 8.5 F stents were placed in 35/79 (44%) insertion attempts, 10 F in 44/79 (56%). In 4 procedures, 2 ASF stents were placed side-byside . Retention data was available for 65/76 (85%) stents by abdominal X-ray (nZ1); EGD (nZ10); ERCP (nZ54). Stents remained in place a median of 47 days (range 14-180). Downstream migration occurred in 18 (28%), but 11/18 remained bridging the target stricture. Patency data was available in 54 subsequent ERCP’s and included patent (nZ20/54, 37%), at a median of 41 (range 14-57) days; partial occlusion (nZ26/54, 48%) at a median of 64 (range 26-86) days; and complete occlusion (nZ8/54, 15%) at median of 56 (range 43-180) days. Follow-up pancreatography was available in 54/76 (71%) procedures and SIS was noted in two (4%) which resolved after upsizing of the ASF. No procedure-related perforations or serious complications occurred. Conclusions: 1) In this single center series, placement of large diameter softer PD stents is feasible in most cases and is facilitated by the use of an introducer that extends beyond the stent tip. 2) Retention rate with the new design is high, however, ampullary retention flaps do not completely prevent partial outward migration. 3) In patients with evaluable data, it appears there is a low rate of stent-induced stricturing with this stent material and design. Anchora Sof-Flex stent featuring an ampullary retention flap and an external pigtail