Upfront endoscopic necrosectomy versus step-up endoscopic approach for walled-off pancreatic necrosis: a systematic review and meta-analysis.
Nkengeh Tazinkeng, Fatima Elmustafa, Kristie Liao et al.
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In 30 seconds
This systematic review and meta-analysis compared upfront endoscopic necrosectomy (UEN) with a step-up endoscopic approach (SUEN) for walled-off pancreatic necrosis. It included 5 studies and 548 participants; 4 studies were retrospective comparative cohorts. Pooled results showed no significant difference in clinical success between approaches (RR, 1.04; 95% CI, 0.98-1.11). The review also found no significant differences in technical success, hospital stay, number of interventions, or measured safety outcomes, including bleeding, infection, recurrence, and mortality.
Key findings
- Clinical success did not differ significantly between UEN and SUEN (RR, 1.04; 95% CI, 0.98-1.11).
- No significant differences were found in technical success, length of hospital stay, or interventions required to achieve clinical success.
- Measured safety outcomes, including bleeding, infection, stent events, recurrence, and postprocedure mortality, did not differ significantly.
Why it matters
The findings suggest that available comparative evidence does not establish an advantage for routinely performing necrosectomy upfront rather than using a step-up sequence. This helps frame procedural timing as a decision that may depend on the clinical context, while highlighting that the evidence base remains limited and largely observational.
What to keep in mind
Only 5 studies were included, and 4 were retrospective comparative cohorts; most studies were conducted in the United States.