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

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. Data are available on reasonable request.