58 - Successful EUS-Guided Pancreatic Cyst Chemoablation Safely Allows Reduction in the Intensity of Post Treatment Radiographic Surveillance: Long-Term Follow-Up of Randomized Prospective Data

Wes Heinle, MPH, Brandy Headlee, PA-C, Sydney Rhoades, BS, Matthew Moyer, MD
Penn State Health Milton S. Hershey Medical Center, Hershey, PA

Introduction: EUS-guided pancreatic cyst chemoablation is safe and effective for appropriately selected patients; however, the frequency of radiographic surveillance after successful chemoablation is unknown. Here we report the long-term follow-up of two randomized, prospective, ChARM clinical trials. The performance of a reduced radiographic surveillance protocol was evaluated using clinical and economic outcomes and patient satisfaction metrics.

Methods: Patients who successfully completed one of the two ChARM RCTs were evaluated for durability of response and clinical outcome. Patients were eligible if 3 years or more of follow-up were available and complete. We calculated economic outcomes using 2021 Medicare allowable costs applicable to EUS, MRI, and outpatient clinic visits. We modeled costs of a patient followed by the ChARM Post-treatment Reduced Radiographic Surveillance Protocol compared with a similar patient followed under Fukuoka or ACG guidelines over 5 years. Additionally, patients of long-term surveillance in our clinic were interviewed via a 4 question Likert scale questionnaire.

Results: 51 patients were followed through December 2022. 68% of patients met complete response (≥95% reduction in volume), 20% partial response, and 11% nonresponse. All patients were successfully reduced to annual or less surveillance without recurrence or the development of cyst associated malignancy. Long term durability follow up are shown in the figure. When compared with Fukukoa or ACG guidelines, a patient treated and followed for 5 years using the ChARM Post-Treatment Reduced Radiographic Surveillance Protocol incurred a Medicare allowable cost of $7,200.00 versus $19,437.44 and $12,526.52 if untreated and followed under Fukukoa or ACG guidelines, respectively. The average Likert responses were 2.2±0.9, 2.5±1.0, 1.75±1.1, 2.9±1.2.

Discussion: The ChARM Post-Treatment Reduced Radiographic Surveillance Protocol safely allows a reduction in radiographic surveillance. This protocol allows a 63.0% reduction in cost associated with cyst management in a comparable patient following Fukukoa guidelines and 43.0% less than ACG guidelines. According to the interview, most patients reported a moderate level of logistical and emotional burden associated with MRI surveillance, and a majority were in favor of reducing the frequency of radiographic surveillance, if it can be done without a marked increase in oncologic risk. Surprisingly, patients surveyed did not report a financial burden with surveillance.



Disclosures:


Wes Heinle, MPH, Brandy Headlee, PA-C, Sydney Rhoades, BS, Matthew Moyer, MD, 58, Successful EUS-Guided Pancreatic Cyst Chemoablation Safely Allows Reduction in the Intensity of Post Treatment Radiographic Surveillance: Long-Term Follow-Up of Randomized Prospective Data, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.