Outcomes of Endoscopic Management of Sterile Walled-Off Pancreatic Necrosis: A Systematic Review

The aim of this study is to systematically review outcomes related to treatment success, mortality, and adverse events of endoscopic management in patients with sterile walled-off pancreatic necrosis.

We reviewed studies published from 2008 to 2018 from Medline and Embase that evaluated the endoscopic treatment of necrotizing pancreatitis. The primary outcome was success of treatment in resolving the collection. Secondary outcomes included length of hospitalization, mortality rate, and adverse events.

Five studies were included, which entailed a total of 280 patients with a mean age of 51.8 years. The primary indication for endoscopic treatment was symptomatic walled-off pancreatic necrosis. Four studies used endoscopic transmural drainage, one of them combining percutaneous drainage and 1 study performed transpapillary drainage. The pooled treatment success was 94.3% with a mean time to resolution of 77.8 days. The mean length of stay was 16.3 days, and mortality rate was 1.3%. The overall adverse event rate was 24.6%, with bleeding the most common adverse event (11%), followed by pancreatic fistula formation (3.4%) and perforation (2.7%).

Although endoscopic management of sterile pancreatic necrosis has a high rate of treatment success, there is a relatively high rate of adverse events, bleeding being the most common.