Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Endosc. Mar 16, 2026; 18(3): 116865
Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.116865
Published online Mar 16, 2026. doi: 10.4253/wjge.v18.i3.116865
Between step-up and upfront intervention: Risk stratification as the missing link in timing endoscopic necrosectomy
Ana-Maria Singeap, Stefan Chiriac, Horia Minea, Anca Trifan, Department of Gastroenterology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
Co-first authors: Ana-Maria Singeap and Stefan Chiriac.
Author contributions: Singeap AM designed the editorial; Singeap AM and Chiriac S contributed equally to this article, they are the co-first authors of this manuscript; Chiriac S and Minea H wrote the paper; Trifan A revised the paper for important intellectual content; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Stefan Chiriac, Assistant Professor, Department of Gastroenterology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Bd. Independentei 1, Iasi 700115, Romania. stefannchiriac@yahoo.com
Received: November 24, 2025
Revised: December 24, 2025
Accepted: January 13, 2026
Published online: March 16, 2026
Processing time: 110 Days and 17.5 Hours
Revised: December 24, 2025
Accepted: January 13, 2026
Published online: March 16, 2026
Processing time: 110 Days and 17.5 Hours
Core Tip
Core Tip: This article highlights the importance of the recently published study by Lone et al, which identifies key clinical, biochemical, and imaging predictors of passive drainage failure in patients with walled-off pancreatic necrosis. By demonstrating that factors such as necrosis extent, persistent inflammation, and poor nutritional reserve can predict the need for direct endoscopic necrosectomy, the study shifts the focus from a time-based step-up protocol toward a risk-based, individualized approach. These findings underscore that in walled-off pancreatic necrosis management, the key question is not when to intervene, but in whom waiting may be riskier than acting.