Selection strategy for endoscopic necrosectomy approaches of infected walled-off pancreatic necrosis: Analysis of 101 patients from a single center with long-term follow-up

ObjectivesEndoscopic necrosectomy (EN) is a promising minimally invasive approach for treating infected walled-off pancreatic necrosis (WOPN). Multiple EN approaches are currently available, though criteria for selecting the optimal approaches are lacking. We aimed to propose a rational selection strategy of EN and to retrospectively evaluate its safety and effectiveness.MethodsAltogether 101 patients who underwent EN for infected WOPN at a tertiary hospital between June 2009 and February 2023 were retrospectively included for analysis. Demographic characteristics, details of the EN procedures, procedure-related adverse events, and clinical outcomes were investigated.ResultsAmong these 101 patients with WOPN, 56 (55.4%) underwent transluminal EN, 38 (37.6%) underwent percutaneous EN, and seven (6.9%) underwent combined approach, respectively. Clinical success was achieved in 94 (93.1%) patients. Seven (6.9%) experienced procedure-related adverse events, and seven (6.9%) died during the treatment period. During a median follow-up of 50 months, 5 (5.3%) of the 94 patients had disease recurrence, 17.0% (16/94) had new-onset diabetes mellitus, and 6.4% (6/94) needed oral pancreatic enzyme supplementation. The clinical success rate, procedure-related adverse event rate, and long-term follow-up outcomes were not significantly different among the three groups. High APACHE-II scores (>= 15) and organ failure were identified as factors related to treatment failure.ConclusionsA selection strategy for EN approaches, based on the extent of necrosis and its distance from the gastrointestinal lumen (using a threshold of 15 mm), is safe and effective for treating infected WOPN in both short-term and long-term outcomes. This retrospective study proposed a selection strategy for endoscopic necrosectomy approaches of infected walled-off pancreatic necrosis (WOPN) based on the location of necrosis, which could assist endoscopists in making the most appropriate clinical decisions, ultimately leading to improved clinical success rate, and decreased complication and mortality rates. CECT, contrast-enhanced computed tomography; CEN, combined endoscopic necrosectomy; GI, gastrointestinal; PD, percutaneous drainage; PEN, percutaneous endoscopic necrosectomy; TD, transluminal drainage; TEN, transluminal endoscopic necrosectomy.image