S2174 Safety of Endoscopic Drainage of Pancreatic Fluid Collections in Patients With Compensated and Decompensated Cirrhosis, a US Collaborative Comparative Analysis

Introduction: Endoscopic drainage (ED) is increasingly utilized for patients with pancreatic fluid collections. However, the safety of ED in patients with cirrhosis remains underexplored. This study aims to evaluate the safety and outcomes of ED in patients with compensated and decompensated cirrhosis compared to non-cirrhotic controls. Methods: A retrospective cohort study was conducted using the TriNetX database. CPT and ICD codes were utilized to identify patients with pancreatic fluid collections, including pseudocysts and walled-off necrosis, who underwent ED. Patients were stratified into 3 groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) was conducted, adjusting for demographics and comorbidities. Outcomes were assessed within 60 days of the procedure. Primary outcomes were gastrointestinal (GI) hemorrhage, sepsis, peritonitis, and overall mortality. Secondary outcomes were the need for repeat endoscopic interventions and blood transfusions. Results: A total of 946 cirrhotic patients (including 234 compensated and 712 decompensated) who underwent cystgastrostomy were included, and 9,041 patients were identified as non-cirrhotic controls. After PSM, when compared to non-cirrhotic controls, the decompensated cirrhosis patients had significantly higher rates of GI hemorrhage (aOR 2.37; 95% CI 1.50–3.75), sepsis (aOR 4.31; 95% CI 3.06–6.10), blood transfusion (aOR 1.90; 95% CI 1.31–2.75), peritonitis (aOR 4.77; 95% CI 2.82–5.68), repeat endoscopic interventions (aOR 1.74; 95% CI 1.41–2.16), and overall mortality (aOR 2.90; 1.72–4.89) (P value < 0.001, for all). Variceal bleeding (1.41%) was observed exclusively in the decompensated group, with no events reported in controls. In contrast, when compared to controls, the compensated cirrhosis group had no significant difference in rates of GI hemorrhage, sepsis, peritonitis, blood transfusion, and mortality. However, the rates of endoscopic interventions were significantly higher in the compensated cirrhosis patients (aOR 1.49 (1.02–2.16), P = 0.037). Conclusion: Endoscopic drainage of pancreatic fluid collections in patients with decompensated cirrhosis was associated with significantly higher risk of GI hemorrhage, sepsis, blood transfusion, and repeat endoscopic procedures when compared to non-cirrhotic controls. However, the procedure appeared safe in compensated cirrhosis.