Percutaneous Endoscopic Necrosectomy of Walled-Off Pancreatic and Peripancreatic Necrosis

TL;DR

A new minimally invasive technique called percutaneous endoscopic necrosectomy is shown to be effective in treating severe pancreatic and peripancreatic necrosis when traditional methods are insufficient.

Contribution

The study introduces and evaluates a novel percutaneous endoscopic necrosectomy technique as an adjunct to transmural drainage for treating extensive walled-off necrosis.

Findings

Percutaneous endoscopic necrosectomy was used in 9 out of 39 patients requiring additional drainage.

Clinical and long-term success was achieved in 88.89% of patients who underwent the procedure.

Treatment-related complications occurred in 22.22% of patients who received percutaneous endoscopic necrosectomy.

Abstract

Background: Minimally invasive approaches for managing complications of acute necrotizing pancreatitis have advanced significantly in recent decades. When extensive walled-off pancreatic or peripancreatic necrosis is present, a single transluminal access may be insufficient. This study aimed to prospectively evaluate the effectiveness and safety of a novel percutaneous endoscopic necrosectomy technique used as an adjunct to transmural drainage in patients with symptomatic walled-off necrosis. Methods: A total of 513 consecutive patients with symptomatic walled-off pancreatic or peripancreatic necrosis treated between 2018 and 2025 at a single tertiary center in Poland were included. All patients underwent minimally invasive endoscopic management. Among them, a subgroup required additional percutaneous drainage. The innovative technique involved creating retroperitoneal percutaneous access to the necrotic cavity, enlarging the tract, and placing a self-expanding metal stent to allow passage of the endoscope for percutaneous endoscopic necrosectomy. Results: Additional percutaneous drainage was necessary in 39/513 patients (7.6%). Of these, 9/39 (23.1%) patients (2 women, 7 men; mean age 46.7 years) underwent percuaneous endoscopic necrosectomy. The mean size of the necrotic collection was 25.96 cm. Active percutaneous drainage during ongoing transmural endotherapy lasted a median of 15 days. Patients underwent an average of 3.12 necrosectomy sessions. Treatment-related complications occurred in 2/9 patients (22.22%). Clinical and long-term success were each achieved in 8/9 patients (88.89%). Conclusions: Percutaneous endoscopic necrosectomy is a promising minimally invasive therapeutic option for extensive walled-off pancreatic and peripancreatic necrosis, particularly when necrosis extends into the pelvic region. However, clinical evidence remains limited and further studies are needed.

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