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  • Severe acute pancreatitis in the era of endoscopically placed lumen-apposing metal stents (LAMS): critical care outcomes from a large UK pancreatobiliary centre

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Pancreatobiliary
Original research
Severe acute pancreatitis in the era of endoscopically placed lumen-apposing metal stents (LAMS): critical care outcomes from a large UK pancreatobiliary centre
  1. Alexander Johnson Parker1,
  2. Greg Tokwabilula1,
  3. Lakshmi Narsinganallore Venkatesh1,
  4. Rana Bhattacharya2,
  5. Jonathan Bannard-Smith1,
  6. Daniel Haley1,
  7. Abubaker Y M Ahmed3,
  8. Anthony Wilson1,
  9. Joe Geraghty3
  1. 1 Dept Adult Critical Care, Manchester University NHS Foundation Trust, Manchester, UK
  2. 2 Dept Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
  3. 3 Dept Gastroenterology, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Alexander Johnson Parker; alexander.parker{at}mft.nhs.uk

Abstract

Objectives 1. Describe characteristics of patients with severe acute pancreatitis (SAP) requiring admission to Critical Care, including interventional management of pancreatic fluid collections.

2. Quantify whether patients requiring drainage of collections via a Lumen-Apposing Metal Stent (LAMS) have different patient experiences and demands on critical care and pancreatic services, compared with those without.

3. Identify possible standards of care to help guide management and to evaluate these standards in current practice.

Design/Method Retrospective observational study of patients admitted to the adult Critical Care Unit at Manchester Royal Infirmary with SAP between 1st January 2019 and 16th June 2022 using Intensive Care National Audit &and Research Centre (ICNARC) data and electronic patient records.

Results There were 96 admissions during 90 hospital episodes with a median admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score of 14. LAMS insertion was undertaken in 32%. Mean time to insertion was 49 days after initial presentation. Percutaneous drainage was undertaken in 30% and surgical management in 10%.

Major bleeding was observed in 6% of LAMS patients and 5% of non-LAMS patients. 90% of LAMS patients were discussed in a specialist MDT, 84% underwent CT imaging within 7 days days prior to LAMS insertion and 26% underwent deep microbiological sampling via the LAMS.

Median total hospital length of stay was 68 days and mortality at ultimate hospital discharge was 23%.

Conclusion Critically ill patients with SAP have a long length of stay. Mortality rates are in keeping with predicted APACHE II scores. Technological advances have created a need for new optimizedoptimised treatment pathways, auditable by adherence to validated standards of care.

  • ACUTE PANCREATITIS
  • STENTS
  • PANCREATIC PSEUDOCYST
  • AUDIT
  • ENDOSCOPIC PROCEDURES

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/flgastro-2024-102657

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • X @drlak19

    • Contributors AJP and JG wrote the manuscript with input from all authors. AJP, JG, GT and LNV conceived the study and were in charge of overall direction, planning and data collection. AJP and JG are the guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.