Clinical outcomes of endoscopic management of pancreatic fluid collections in cirrhotics vs non-cirrhotics: A comparative study

Table 1 Demographic and clinical data

Factor	Non-cirrhotic (n = 25)	Cirrhotic (n = 5)	Difference (95%CI)	P value
Age	48.8 ± 15.8	57.8 ± 13.7	9.0 (-6.6, 24.6)	0.25a
Gender				0.62d
Male	14 (56.0)	4 (80.0)	24.0 (-26.1, 71.6)
Female	11 (44.0)	1 (20.0)
Anti-platelets	4 (16.0)	3 (60.0)	44.0 (-6.3, 85.3)	0.068d
Charlson co-morbidity index	80.4 ± 29.4	50.4 ± 37.2	-30.0 (-60.8, 0.73)	0.055a
Type of PFC				0.99d
WON	10 (40.0)	2 (40.0)	0.00 (-52.2, 52.2)
Pseudocyst	15 (60.0)	3 (60.0)
Location of PFC				0.62d
Head	9 (36.0)	1 (20.0)	-16.0 (-64.4, 33.8)
Body	14 (56.0)	3 (60.0)	4.0 (-45.0, 52.4)
Tail	2 (8.0)	1 (20.0)	12.0 (-37.5, 60.1)
Size of PFC (mm)	122.9 ± 61.2	125.2 ± 68.4	2.3 (-60.2, 64.8)	0.94a
Extension of fluid collection to paracolic gutter	6 (24.0)	1 (20.0)	-4.0 (-52.4, 45.0)	0.99d
Pancreatic Duct on imaging				0.99d
No leak	18 (72.0)	4 (80.0)	8.0 (-41.3, 56.2)
Leak	3 (12.0)	0 (0.0)	-12.0 (-60.1, 37.5)
Complete disruption	4 (16.0)	1 (20.0)	4.0 (-45.0, 52.4)
Indication of collection drainage				0.17d
Gastric outlet obstruction	7 (28.0)	2 (40.0)	12.0 (-37.5, 60.1)
Abdominal pain	12 (48.0)	1 (20.0)	-28.0 (-71.6, 22.2)
Early satiety	4 (16.0)	0 (0.0)	-16.0 (-64.4, 33.8)
Rapid increase in size	2 (8.0)	1 (20.0)	12.0 (-37.5, 60.1)
Jaundice	0 (0.0)	1 (20.0)	20.0 (-29.9, 71.6)
Etiology of pancreatitis				0.24d
Gallstones	10 (40.0)	1 (20.0)	-20.0 (-71.6, 29.9)
Alcohol	8 (32.0)	4 (80.0)	48.0 (-2.2, 85.3)
Other	7 (28.0)	0 (0.0)	-28.0 (-71.6, 22.2)
Platelets	248.7 ± 101.3	132.6 ± 57.5	-116.1 (-214.5, -17.7)	0.023a
Alkaline Phosphatase	103.3 ± 57.3	790.8 ± 1461.4	687.5 (54.8, 1320.2)	0.034a
ALT	31.2 ± 36.4	100.6 ± 169.0	69.4 (-11.1, 149.9)	0.088a
AST	36.5 ± 50.9	173.6 ± 272.9	137.1 (10.0, 264.2)	0.036a
Bilirubin	0.61 ± 0.48	3.3 ± 3.1	2.7 (1.2, 4.1)	< 0.001a
INR	1.1 ± 0.12	1.3 ± 0.30	0.24 (0.06, 0.42)	0.012a

Statistics presented as mean ± SD, or n (%). P values:

^aANOVA; ^bFisher’s exact test. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PFC: Pancreatic fluid collection; INR: International normalized ratio; WON: Walled off necrosis.

Table 2 Characteristics of cirrhotic patients

Factor	Cirrhotic (n = 5)
	Statistics
MELD score	16.2 ± 7.9
MELD (90 d/3 mo mortality)	20.0 ± 19.7
Child-Pugh Classification
A	1 (20.0)
B	4 (80.0)
Esophageal varices	3 (60.0)
Grade varices
I	3 (100.0)
Gastric varices	1 (20.0)
PHG	2 (40.0)
Previous UGI bleeding	0 (0.0)
Chronic kidney disease	2 (40.0)
Use of NSSB	0 (0.0)

Statistics presented as mean ± SD or n (%). MELD: Model of end-stage liver disease; NSSB: Non selective beta blocker; PHG: Portal hypertensive gastropathy; UGI: Upper gastrointestinal.

Table 3 Intra-procedure data

Factor	Non-cirrhotics	Cirrhotics	Statistics	P value
Stent type				0.14d
Hot axios	9 (36.0)	4 (80.0)	44.0 (-6.3, 85.3)
FCSEMS	16 (64.0)	1 (20.0)
Drainage approach				0.99d
Transgastric	24 (96.0)	5 (100.0)	4.0 (-45.0, 52.4)
Transduodenal	1 (4.0)	0 (0.0)
Tract dilation	16 (64.0)	1 (20.0)	-44.0 (-85.3, 6.3)	0.14d
Technical Success	25 (100.0)	5 (100.0)	-	-
Endoscopic necrosectomy	7 (28.0)	2 (40.0)	12.0 (-37.5, 60.1)	0.62d
Hydrogen peroxide irrigation	14 (56.0)	2 (40.0)	-16.0 (-64.4, 33.8)	0.64d
Need for concomitant percutaneous drainage	1 (4.0)	0 (0.0)	-4.0 (-52.4, 45.0)	0.99d

Statistics presented as mean ± SD or n (%). P values: ^aANOVA; ^bFisher’s exact test. FCSEMS: Fully-covered self-expandable stents.

Table 4 Post-procedure outcomes

Factor	Non-cirrhotics	Cirrhotics	Statistics	P value
Clinical success	23 (92.0)	3 (60.0)	-32.0 (-75.2, 18.3)	0.12d
Successful stent removal following resolution	20 (80.0)	3 (60.0)	-20.0 (-71.6, 29.9)	0.57d
Total number of endoscopic procedures prior to removal	1.5 ± 0.94	2.0 ± 1.7	0.55 (-0.80, 1.9)	0.41a
ERCP performed within 30 d post drainage	5 (20.0)	1 (20.0)	0.00 (-52.2, 52.2)	0.99d
Recurrence of PFC needing reintervention	4 (16.0)	0 (0.0)	-16.0 (-60.1, 37.5)	0.99d
Need for surgery	2 (8.0)	0 (0.0)	-8.0 (-56.2, 41.3)	0.99d
Any adverse events	7 (28.0)	3 (60.0)	12.0 (-37.5, 60.1)	0.62d
Bleeding	1 (4.0)	1 (20.0)	16.0 (-33.8, 64.4)	0.31d
Infection	5 (20.0)	2 (40.0)	20.0 (-29.9, 71.6)	0.57d
Stent migration	1 (4.0)	0 (0.0)	-4.0 (-52.4, 45.0)	0.99d
Any severe AE	2 (8.0)	0 (0.0)	-8.0 (-56.2, 41.3)	0.99d
Any fatal AE	0 (0.0)	2 (40.0)	40.0 (-10.3, 85.3)	0.023d
Any severe/fatal AE	2 (8.0)	2 (40.0)	32.0 (-18.3, 75.2)	0.12d
Length of post-procedure hospitalization (d)	5.6 ± 13.7	18.6 ± 20.3	13.0 (-1.9, 27.9)	0.084a
Follow-up (mo)	14.1 ± 9.5	5.5 ± 5.1	-8.6 (-17.6, 0.49)	0.063a

Statistics presented as mean ± SD or n (%). P values:

^aANOVA; ^bFisher’s exact test. AE: Adverse event; ERCP: Endoscopic retrograde cholangiopancreatography; PFC: Pancreatic fluid collection.