Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures

Julie Falkebo Jensen; Joy Stinne Timmner; Amer Hadi; Erik Feldager; August Pilegaard Prahm; Mohamed Ebrahim; Gitte Aabye Olsen; Stine Roug; Srdan Novovic; John Gásdal Karstensen

doi:10.1055/a-2737-6307

Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures

Julie Falkebo Jensen, Joy Stinne Timmner, Amer Hadi, Erik Feldager, August Pilegaard Prahm, Mohamed Ebrahim, Gitte Aabye Olsen, Stine Roug, Srdan Novovic, John Gásdal Karstensen^*

^*Corresponding author for this work

Gastro Unit

Abstract

BACKGROUND AND STUDY AIMS: Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.

PATIENTS AND METHODS: We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.

RESULTS: A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2-5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3%). Snares were used in most procedures (90.9%), EndoRotor in 4.3%, and both were used in 4.8% of procedures. A total of 14 AEs (1.6%) were identified in 11 different patients (4.7%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5%) than in the non-AE group (10.3%, P = 0.0004).

CONCLUSIONS: AEs are rare in EN but are associated with increased mortality.

Original language	English
Article number	a27376307
Journal	Endoscopy International Open
Volume	13
ISSN	2364-3722
DOIs	https://doi.org/10.1055/a-2737-6307
Publication status	Published - 2025

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10.1055/a-2737-6307Licence: CC BY

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Jensen, J. F., Stinne Timmner, J., Hadi, A., Feldager, E., Prahm, A. P., Ebrahim, M., Olsen, G. A., Roug, S., Novovic, S., & Karstensen, J. G. (2025). Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures. Endoscopy International Open, 13, Article a27376307. https://doi.org/10.1055/a-2737-6307

@article{a540f0c751664cb8abb0fe01d5b56fd1,

title = "Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures",

abstract = "BACKGROUND AND STUDY AIMS: Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.PATIENTS AND METHODS: We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.RESULTS: A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2-5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3\%). Snares were used in most procedures (90.9\%), EndoRotor in 4.3\%, and both were used in 4.8\% of procedures. A total of 14 AEs (1.6\%) were identified in 11 different patients (4.7\%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5\%) than in the non-AE group (10.3\%, P = 0.0004).CONCLUSIONS: AEs are rare in EN but are associated with increased mortality.",

author = "Jensen, \{Julie Falkebo\} and \{Stinne Timmner\}, Joy and Amer Hadi and Erik Feldager and Prahm, \{August Pilegaard\} and Mohamed Ebrahim and Olsen, \{Gitte Aabye\} and Stine Roug and Srdan Novovic and Karstensen, \{John G{\'a}sdal\}",

note = "The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).",

year = "2025",

doi = "10.1055/a-2737-6307",

language = "English",

volume = "13",

journal = "Endoscopy International Open",

issn = "2364-3722",

publisher = "GeorgThieme Verlag",

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TY - JOUR

T1 - Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis

T2 - Insights from a tertiary center study of 880 procedures

AU - Jensen, Julie Falkebo

AU - Stinne Timmner, Joy

AU - Hadi, Amer

AU - Feldager, Erik

AU - Prahm, August Pilegaard

AU - Ebrahim, Mohamed

AU - Olsen, Gitte Aabye

AU - Roug, Stine

AU - Novovic, Srdan

AU - Karstensen, John Gásdal

N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

PY - 2025

Y1 - 2025

N2 - BACKGROUND AND STUDY AIMS: Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.PATIENTS AND METHODS: We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.RESULTS: A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2-5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3%). Snares were used in most procedures (90.9%), EndoRotor in 4.3%, and both were used in 4.8% of procedures. A total of 14 AEs (1.6%) were identified in 11 different patients (4.7%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5%) than in the non-AE group (10.3%, P = 0.0004).CONCLUSIONS: AEs are rare in EN but are associated with increased mortality.

AB - BACKGROUND AND STUDY AIMS: Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.PATIENTS AND METHODS: We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.RESULTS: A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2-5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3%). Snares were used in most procedures (90.9%), EndoRotor in 4.3%, and both were used in 4.8% of procedures. A total of 14 AEs (1.6%) were identified in 11 different patients (4.7%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5%) than in the non-AE group (10.3%, P = 0.0004).CONCLUSIONS: AEs are rare in EN but are associated with increased mortality.

U2 - 10.1055/a-2737-6307

DO - 10.1055/a-2737-6307

M3 - Journal article

C2 - 41567603

SN - 2364-3722

VL - 13

JO - Endoscopy International Open

JF - Endoscopy International Open

M1 - a27376307

ER -

Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures

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