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KMID : 1038120210540060909
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Clinical Endoscopy
2021 Volume.54 No. 6 p.909 ~ p.915
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RWON Study: The Real-World Walled-off Necrosis Study
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Pawar Ankush
Sonika Ujjwal
Kumar Manish
Saluja Sundeep Singh
Srivastava Siddharth
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Abstract
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Background/Aims: The management of 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 (ED), or a combination of PCD and ED. We compared clinical outcome among these modalities.
Results: A total of 264 patients were evaluated. The most common indications for drainage were pain and fever. Of the patients, 28% was treated with medical therapy alone, 31% with ED, 37% with PCD, and 4% with a combined approach. Technical success and clinical success were achieved in 93% and 91% of patients in the endoscopic arm and in 90% and 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: ED of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.
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KEYWORD
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Drainage, Endoscopic ultrasound, Necrosis, Pancreatitis, Self-expandable metallic stent
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