Early (<4 Weeks) Versus Standard (≥ 4 Weeks) Endoscopically Centered Step-Up Interventions for Necrotizing...

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Interventional Endoscopy

Background:

• Current necrotizing pancreatitis (NP) guidelines advocate delaying intervention until collections wall off (≥4 weeks).
• However, clinical deterioration due to infection may necessitate earlier intervention.
• Data on early endoscopic intervention outcomes in NP is limited.

Purpose of the Study:

• To compare outcomes of an endoscopic step-up approach for NP initiated early (<4 weeks) versus standard timing (≥4 weeks).

Main Methods:

• A retrospective analysis of 193 patients with NP requiring intervention via an endoscopic step-up approach.
• Interventions were categorized as early (<4 weeks) or standard (≥4 weeks) based on timing.
• Outcomes including mortality, morbidity, complications, and length of stay were compared.

Main Results:

• Early intervention (n=76) was more frequently for infection (91% vs. 39%) and associated with higher rates of acute kidney injury, respiratory failure, and shock compared to standard intervention (n=117).
• Despite this, organ failure improved significantly in both groups.
• Early intervention showed higher mortality (13% vs. 4%) and increased need for open necrosectomy (7% vs. 1%), with longer median hospital (37 vs. 26 days) and ICU stays (2.5 vs. 0 days). No difference in complications was observed.

Conclusions:

• An endoscopic step-up strategy for NP allows for early intervention (<4 weeks) in cases of infection or organ failure.
• This approach yields similar organ failure improvement and no increase in complications, despite a slightly higher need for surgery and longer hospitalizations.
• Early endoscopic intervention should be considered for NP when strongly indicated.