Interdisciplinary Step-Up Strategy for Infected Pancreatic Walled-Off Necrosis: Sinus Tract Endoscopic Necrosectomy...

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Acute infected necrotizing pancreatitis presents significant morbidity and mortality.
• The step-up approach, combining percutaneous drainage with necrosectomy, improves outcomes over open surgery.
• Laparoscopic-assisted necrosectomy (LAPN) is used for infected walled-off necrosis (WON) post-drainage.

Purpose of the Study:

• To evaluate the efficacy of sinus tract endoscopy guided necrosectomy (STEN) compared to LAPN.
• To assess STEN as a less invasive alternative for managing infected WON within a step-up approach.
• To compare clinical outcomes and complication rates between STEN and LAPN.

Main Methods:

• Retrospective analysis of 17 patients with infected WON managed via a step-up approach (2019-2025).
• Patients underwent CT-guided percutaneous drainage followed by either STEN (n=9) or LAPN (n=8).
• Primary endpoint: composite of major complications and 6-month mortality; secondary endpoints: overall complications, reinterventions, and hospital stay.

Main Results:

• Six of nine (66.7%) STEN patients met the primary endpoint (major complications, no mortality).
• Four of eight (50.0%) LAPN patients met the primary endpoint (3 major complications, 1 death).
• Both STEN and LAPN demonstrated comparable outcomes in managing infected WON.

Conclusions:

• Both STEN and LAPN are effective in treating infected WON within the step-up approach.
• STEN offers a potentially less invasive option with comparable efficacy to LAPN.
• Findings are exploratory due to small sample size; larger studies are warranted to confirm STEN's role.