Outcomes of a Structured, Stepwise Approach to Endoscopic Necrosectomy

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery

Background:

• Direct endoscopic necrosectomy (DEN) is crucial for necrotizing pancreatitis but lacks a standardized approach.
• Current DEN methods are labor-intensive and vary in application, impacting efficiency.

Purpose of the Study:

• To prospectively validate a structured, stepwise approach to DEN.
• To enhance procedural efficiency and optimize resource utilization in DEN.

Main Methods:

• A 2-phase study involving patients with necrotizing pancreatitis requiring DEN.
• Phase I: Retrospective analysis of unstructured DEN. Phase II: Prospective validation of a 3-step structured approach (debridement, extraction, irrigation).
• Outcome measure: Procedural efficiency, defined by the number of necrosectomy sessions to achieve treatment success.

Main Results:

• Treatment success rates were comparable between unstructured (80.0%) and structured (94.9%) DEN.
• The structured approach significantly reduced the median number of DEN sessions required for success (2 vs. 3 sessions, P=0.003).
• A structured approach was independently associated with fewer necrosectomy sessions (OR=4.7, P=0.008).

Conclusions:

• A structured, stepwise approach to DEN enhances procedural efficiency.
• This standardized method reduces the number of interventions needed for successful necrotizing pancreatitis treatment.