Early Endoscopic Interventions for Pancreatic Necrosis: Indications, Technique, and Outcomes

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Pancreatic Diseases

Background:

• Walled-off necrosis (WON) in acute necrotising pancreatitis (ANP) typically requires intervention in the delayed phase (>4 weeks).
• Early intervention (<4 weeks) was historically avoided due to risks associated with incomplete encapsulation and poor tissue demarcation.

Purpose of the Study:

• To review the current indications, techniques, and outcomes of early endoscopic transluminal drainage for pancreatic necrotic collections.
• To evaluate the safety and efficacy of emerging endoscopic approaches in managing ANP.

Main Methods:

• Review of current literature and expert tertiary care center data on early endoscopic transluminal drainage.
• Analysis of advancements in endoscopic technology, including lumen-apposing metal stents and necrosectomy accessories.

Main Results:

• Emerging data suggests early endoscopic transluminal drainage is effective and safe for symptomatic WON.
• Advancements in endoscopic tools have expanded the indications for pancreatic necrosis drainage.
• Early drainage is associated with higher adverse event rates, emphasizing the need for careful patient selection.

Conclusions:

• Early endoscopic transluminal drainage is a viable option for selected patients with ANP.
• Technological innovations have improved the feasibility and outcomes of endoscopic pancreatic necrosis management.
• Optimizing patient selection remains critical for minimizing complications associated with early intervention.