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Background <p>Acute infected necrotizing pancreatitis is characterized by high rates of systemic infection with organ failure and mortality. The step-up approach combining percutaneous drainage with laparoscopic-assisted pancreatic necrosectomy (LAPN) or transgastric necrosectomy shows a lower incidence of complications and mortality than open necrosectomy. This study aimed at comparing minimal-invasive percutaneous and endoscopic step-up approach.</p> Methods <p>A retrospective analysis of patients undergoing the step-up approach for infected necrotizing pancreatitis between 2019 and 2023 was conducted. Percutaneous treatment involved CT-guided percutaneous drainage followed by LAPN if needed, while the endoscopic approach used transgastric drainage and endoscopic necrosectomy. Primary outcome was a composite of major complications or 6-month mortality. Secondary outcomes included complication rates, number of reinterventions, duration of hospital stay and mortality.</p> Results <p>The study included 31 patients. Eighteen patients underwent the percutaneous step-up approach, consisting of CT-guided drainage, followed by LAPN in 11 cases (61.1%). Thirteen patients were treated endoscopically which involved transgastric drainage, followed by necrosectomy in 7 cases (53.8%). The composite of major complications or death occurred in 55.6% of the percutaneous group and in 53.8% of the endoscopic group. Postoperative major complications were reported in eight patients in the percutaneous group and five in the endoscopic group. Four patients required LAPN after endoscopic necrosectomy due to insufficient improvement.</p> Conclusion <p>LAPN and endoscopic necrosectomy are effective in controlling local and systemic infection in severe necrotizing pancreatitis. LAPN remains important in managing extensive infected necrosis, particularly when transgastric methods cannot fully address the necrosis cavity.</p>

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Minimal-invasive percutaneous step-up approach compared to endoscopic procedures in the treatment of walled off pancreatic necrosis: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月29日

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  • Valerie Kremo,
  • Hanna Plazer,
  • Julia Mühlhäusser,
  • Andreas Scheiwiller,
  • Stephan Baumeler,
  • Simon Bütikofer,
  • Juerg Metzger,
  • Martin Bolli,
  • Francesco Mongelli,
  • Jörn-Markus Gass

摘要

Background

Acute infected necrotizing pancreatitis is characterized by high rates of systemic infection with organ failure and mortality. The step-up approach combining percutaneous drainage with laparoscopic-assisted pancreatic necrosectomy (LAPN) or transgastric necrosectomy shows a lower incidence of complications and mortality than open necrosectomy. This study aimed at comparing minimal-invasive percutaneous and endoscopic step-up approach.

Methods

A retrospective analysis of patients undergoing the step-up approach for infected necrotizing pancreatitis between 2019 and 2023 was conducted. Percutaneous treatment involved CT-guided percutaneous drainage followed by LAPN if needed, while the endoscopic approach used transgastric drainage and endoscopic necrosectomy. Primary outcome was a composite of major complications or 6-month mortality. Secondary outcomes included complication rates, number of reinterventions, duration of hospital stay and mortality.

Results

The study included 31 patients. Eighteen patients underwent the percutaneous step-up approach, consisting of CT-guided drainage, followed by LAPN in 11 cases (61.1%). Thirteen patients were treated endoscopically which involved transgastric drainage, followed by necrosectomy in 7 cases (53.8%). The composite of major complications or death occurred in 55.6% of the percutaneous group and in 53.8% of the endoscopic group. Postoperative major complications were reported in eight patients in the percutaneous group and five in the endoscopic group. Four patients required LAPN after endoscopic necrosectomy due to insufficient improvement.

Conclusion

LAPN and endoscopic necrosectomy are effective in controlling local and systemic infection in severe necrotizing pancreatitis. LAPN remains important in managing extensive infected necrosis, particularly when transgastric methods cannot fully address the necrosis cavity.