Zeng Y, Zhang JW, Yang J. Endoscopic management of infected necrotizing pancreatitis: Advancing through standardization. World J Gastroenterol 2025; 31(20): 107451 [DOI: 10.3748/wjg.v31.i20.107451]
Corresponding Author of This Article
Jian Yang, MD, PhD, Associate Chief Physician, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. yj1984ren@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. May 28, 2025; 31(20): 107451 Published online May 28, 2025. doi: 10.3748/wjg.v31.i20.107451
Endoscopic management of infected necrotizing pancreatitis: Advancing through standardization
Yan Zeng, Jun-Wen Zhang, Jian Yang
Yan Zeng, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Jun-Wen Zhang, Jian Yang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Zeng Y and Yang J performed the literature search, analyzed the data, and wrote the original manuscript; Zhang JW and Yang J performed the endoscopic procedures, conceptualized and designed the research, and edited the final manuscript; all authors have read and approved the final manuscript.
Supported by the Education and Teaching Reform Project of the First Clinical College of Chongqing Medical University, No. CMER202305; Natural Science Foundation of Tibet Autonomous Region, No. XZ2024ZR-ZY100(Z); and Program for Youth Innovation in Future Medicine, Chongqing Medical University, China, No. W0138.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Yang, MD, PhD, Associate Chief Physician, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. yj1984ren@qq.com
Received: March 24, 2025 Revised: April 12, 2025 Accepted: May 12, 2025 Published online: May 28, 2025 Processing time: 65 Days and 18.2 Hours
Abstract
Infected necrotizing pancreatitis (INP) remains a life-threatening complication of acute pancreatitis. Despite advancements such as endoscopic ultrasound (EUS)-guided drainage, lumen-apposing metal stents, and protocolized step-up strategies, the clinical practice remains heterogeneous, with variability in endoscopic strategies, procedural timing, device selection, and adjunctive techniques contributing to inconsistent outcomes. This review synthesizes current evidence to contribute to a structured framework integrating multidisciplinary team decision-making, advanced imaging (three-dimensional reconstruction, contrast-enhanced computed tomography/magnetic resonance imaging), EUS assessment, and biomarker-driven risk stratification (C-reactive protein, procalcitonin) to optimize patient selection, intervention timing, and complication management. Key standardization components include endoscopic assessment and procedural strategies, optimal timing of intervention, personalized approaches for complex pancreatic collections, and techniques to reduce the number of endoscopic debridements and mitigate complications. This work aims to enhance clinical outcomes, minimize practice heterogeneity, and establish a foundation for future research and guideline development in endoscopic management of INP.
