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Multicenter Study
. 2025 Jun;101(6):1174.e1-1174.e20.
doi: 10.1016/j.gie.2024.11.039. Epub 2024 Nov 26.

Necrosectomy and its timing in relation to clinical outcomes of EUS-guided treatment of walled-off pancreatic necrosis: a multicenter study

Masahiro Tsujimae  1 , Tomotaka Saito  2 , Arata Sakai  1 , Mamoru Takenaka  3 , Shunsuke Omoto  3 , Tsuyoshi Hamada  4 , Shogo Ota  5 , Hideyuki Shiomi  6 , Sho Takahashi  7 , Toshio Fujisawa  7 , Kentaro Suda  8 , Saburo Matsubara  8 , Shinya Uemura  9 , Takuji Iwashita  9 , Kensaku Yoshida  10 , Akinori Maruta  10 , Mitsuru Okuno  11 , Keisuke Iwata  11 , Nobuhiko Hayashi  12 , Tsuyoshi Mukai  13 , Ichiro Yasuda  12 , Hiroyuki Isayama  7 , Yousuke Nakai  14 , Atsuhiro Masuda  15 ; WONDERFUL study group in Japan
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Free article
Multicenter Study

Necrosectomy and its timing in relation to clinical outcomes of EUS-guided treatment of walled-off pancreatic necrosis: a multicenter study

Masahiro Tsujimae et al. Gastrointest Endosc. 2025 Jun.
Free article

Abstract

Background and aims: EUS-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly used to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared with the drainage-based approach.

Methods: Within a multi-institutional cohort of 423 patients with pancreatic fluid collections, including 227 patients with WON, 153 patients were identified who received the step-up treatment after the initial EUS-guided drainage of symptomatic WON; this included 102 EN patients and 51 non-EN (drainage) patients. Using the competing-risks multivariable proportional hazards regression model with adjustment for potential confounders, we calculated subdistribution hazard ratios (SHRs) for clinical treatment success (WON resolution) according to use of EN and its timing.

Results: Compared with drainage alone, the EN-based treatment was associated with a shorter time to clinical success with a multivariable SHR of 1.66 (95% confidence interval, 1.12-2.46). Despite a higher risk of procedure-related bleeding in the EN group, there were no differences in the rates of severe adverse events (7.8% vs 5.9% in the EN and non-EN groups, respectively) or mortality (6.9% vs 9.8%). In the EN-treated patients, the timing of EN was not statistically significantly associated with the time to clinical success (Ptrend = .34).

Conclusions: Among patients receiving EUS-guided treatment of symptomatic WON, the use of EN in addition to drainage procedures was associated with earlier disease resolution. Further research is desired to determine the optimal timing of initiating EN considering a risk-benefit balance and cost-effectiveness.

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Conflict of interest statement

Disclosure The following authors disclosed financial relationships: H. Isayama: Consultant for Kawasumi Laboratories; speaker for Boston Scientific Japan, Fujifilm Corporation, Piolax Medical Devices, Century Medical, CREATE MEDIC, Gadelius Medical, Fujifilm Healthcare, Japan Lifeline Co, Ltd, KANEKA MEDIX CORP, Kawasumi Laboratories, Olympus, Sumitomo Bakelite Co, Ltd, and Zeon Medical Inc; research support from Boston Scientific Japan, Fujifilm Corporation, Piolax Medical Devices, Century Medical, Gadelius Medical, Fujifilm Healthcare, Japan Lifeline Co, Ltd, and Zeon Medical Inc; patent royalty with Piolax Medical Devices. Y. Nakai: research funding and consulting for Boston Scientific Japan, Fujifilm, Gadelius Medical, Hitachi Medical, and Medico’s Hirata; research funding from Century Medical, HOYA Pentax Medical, and Kaneka; and consulting for Olympus Medical and J-MIT. All other authors disclosed no financial relationships. This work was supported by grants from the Japanese Foundation for Research and Promotion of Endoscopy (to T. Saito and Y. Nakai). T. Hamada was supported by the Japan Society for the Promotion of Science KAKENHI grants (JP19K08362 and JP22H02841) and grants from Takeda Science Foundation and Daiichi Sankyo Company. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

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