Top-down versus step-up approach after endoscopic ultrasound-guided drainage of infected walled-off necrosis: a randomized controlled trial.
EndoscopyJun 1, 2026 (epub)
Clinical ResearchGastroenterology
Sanish Ancil, Jimil Shah, Vaneet Jearth et al.
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In 30 seconds
This randomized controlled trial compared top-down versus step-up approaches after endoscopic ultrasound-guided drainage of infected walled-off necrosis in 54 patients. The top-down group required fewer reinterventions (1 vs. 2; P = 0.02) and had lower readmission rates (18.5% vs. 44.4%; P = 0.04), indicating a potential advantage in clinical outcomes.
Key findings
- Top-down approach resulted in fewer reinterventions (1 vs. 2; P = 0.02).
- Readmission rates were significantly lower in the top-down group (18.5% vs. 44.4%; P = 0.04).
- Length of stay was shorter in the top-down group (4 days vs. 12 days; P <0.001).
- New-onset organ failure and procedure-related adverse events were similar across both groups.
Why it matters
Understanding the optimal approach for managing infected walled-off necrosis can improve patient outcomes, reduce hospital stays, and minimize readmissions, which are critical factors in gastroenterology practice.