Lone SA, Sonika U, Reddy RT, Vaithiyam V, Aneesh PS, Palli SH, Dalal A, Kumar A, Srivastava S, Sachdeva S. Predictive factors and outcomes of endoscopic necrosectomy in patients with acute pancreatitis and walled-off necrosis. World J Gastrointest Endosc 2025; 17(12): 111614 [DOI: 10.4253/wjge.v17.i12.111614]
Corresponding Author of This Article
Venkatesh Vaithiyam, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, 1, Jawaharlal Nahru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, Delhi, India. venkateshvaithiyam172@gmail.com
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Gastroenterology & Hepatology
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Retrospective Study
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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/
Dec 16, 2025 (publication date) through Dec 19, 2025
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lone SA, Sonika U, Reddy RT, Vaithiyam V, Aneesh PS, Palli SH, Dalal A, Kumar A, Srivastava S, Sachdeva S. Predictive factors and outcomes of endoscopic necrosectomy in patients with acute pancreatitis and walled-off necrosis. World J Gastrointest Endosc 2025; 17(12): 111614 [DOI: 10.4253/wjge.v17.i12.111614]
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 111614 Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.111614
Predictive factors and outcomes of endoscopic necrosectomy in patients with acute pancreatitis and walled-off necrosis
Shabir A Lone, Ujjwal Sonika, Ravi Teja Reddy, Venkatesh Vaithiyam, Payila SR Aneesh, Sri Harsha Palli, Ashok Dalal, Ajay Kumar, Siddharth Srivastava, Sanjeev Sachdeva
Shabir A Lone, Ujjwal Sonika, Ravi Teja Reddy, Venkatesh Vaithiyam, Payila SR Aneesh, Sri Harsha Palli, Ashok Dalal, Ajay Kumar, Siddharth Srivastava, Sanjeev Sachdeva, Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi 110002, Delhi, India
Author contributions: Lone SA and Reddy RT wrote the original draft; Sonika U, Vaithiyam V, and Sachdeva S contributed to conceptualization, writing, reviewing, and editing; Aneesh PSR, Palli SH, Kumar A, and Dalal A participated in drafting the manuscript; Sonika U, Vaithiyam V, Kumar A, Srivastava S, and Sachdeva S performed the final review of the manuscript, and all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Maulana Azad Medical College, approval No. F.1/IEC/MAMC/85/04/2021/No. 470.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data particular to the study are available in the Department of Gastroenterology and will be provided upon request.
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: Venkatesh Vaithiyam, Assistant Professor, Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, 1, Jawaharlal Nahru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, Delhi, India. venkateshvaithiyam172@gmail.com
Received: July 7, 2025 Revised: July 30, 2025 Accepted: November 13, 2025 Published online: December 16, 2025 Processing time: 164 Days and 16 Hours
Abstract
BACKGROUND
Endoscopic ultrasound-guided drainage using lumen-apposing metal stents (LAMS) has emerged as the first-line approach for managing walled-off necrosis (WON). However, certain patients require escalation to direct endoscopic necrosectomy, for which the predictive factors have not been completely defined.
AIM
To determine the predictors of direct endoscopic necrosectomy following LAMS placement in patients with WON and to assess the clinical outcomes and safety.
METHODS
A retrospective analysis of prospectively collected data from patients with acute pancreatitis who were admitted to the Govind Ballabh Pant Institute of Postgraduate Medical Education in Delhi, India, between January 2020 and October 2023 was conducted. Patients with acute pancreatitis and symptomatic WON who underwent LAMS placement were included in the study. Patients aged < 18 years with asymptomatic WON, pseudocysts, postsurgical collections, or a history of percutaneous drainage were excluded. Data were collected using a predesigned form. Clinical details, treatments, interventions, and outcome data were recorded.
RESULTS
A total of 104 patients with symptomatic pancreatic WON who underwent LAMS placement were included in this study. Of these, 36 required endoscopic necrosectomy. Univariate analysis revealed that fever [odds ratio (OR) = 4.47, 95% confidence interval (CI): 1.85-10.79, P = 0.00], systemic inflammatory response syndrome (OR = 5.85, 95%CI: 2.03-16.83, P = 0.001), pancreatic necrosis > 30% (OR = 14.6, 95%CI: 1.87-113.86, P = 0.001), WON in the pancreatic head (OR = 4.246, 95%CI: 1.80-10.0, P = 0.001), and collection size (OR = 1.18, 95%CI: 1.04-1.34, P = 0.009) were the predictors of endoscopic necrosectomy. Subsequently, multivariate analysis indicated that the extent of necrosis was an independent predictor of the requirement for necrosectomy (OR = 1.085, 95%CI: 1.026-1.148, P < 0.004). Clinical success was higher in the non-necrosectomy group than in the necrosectomy group (88.2% vs 69.4%).
CONCLUSION
Early identification of these predictive variables can guide treatment planning for WON and facilitate early necrosectomy, thereby improving the clinical outcomes.
Core Tip: Walled-off necrosis (WON) is a well-known complication of acute pancreatitis. Although many patients respond to endoscopic drainage alone, some require direct endoscopic necrosectomy for optimal outcomes. This retrospective study identified the clinical, biochemical, and radiological predictors of necrosectomy in patients undergoing placement of lumen-apposing metal stents. Of the examined factors, fever, anemia, hypoalbuminemia, systemic inflammatory response syndrome, pancreatic necrosis > 30%, WON size, and WON location were predictors of necrosectomy. Early identification of these predictors can guide clinicians in planning timely interventions, thereby improving outcomes and reducing morbidity associated with delayed or unnecessary necrosectomy.
