Predictive factors and outcomes of endoscopic necrosectomy in patients with acute pancreatitis and walled-off necrosis

Figure 1 Magnetic resonance imaging and endoscopic ultrasound guided drainage of lumen-apposing metallic stents. A: Magnetic resonance T2-weighted imaging coronal; B: Axial views showing walled-off necrosis of the pancreas with significant debris; C: Endoscopic ultrasound (EUS) reveals a large walled-off necrosis with echogenic contents and debris (orange arrow); D: EUS-guided lumen-apposing metallic stents (LAMS) are being placed, with distal flanges (yellow arrow) deployed; E: Both distal flanges (yellow arrowhead) inside the cavity and proximal flanges (orange arrowhead) in the gastric cavity are deployed seen in EUS; F: Endoscopic image post-deployment of LAMS and pus seen oozing out from out the LAMS.

Figure 2 The procedure of direct endoscopic necrosectomy. A: Endoscopic image shows blocked lumen-apposing metallic stents with pus seen oozing through it; B: Blockage in the lumen-apposing metallic stents is removed, and the scope is negotiated into the cavity, which shows a large cavity with necrotic debris; C: Necrotic debris is removed with Roth net forceps; D: Post-necrosectomy with minimal debris and healthy wall cavity seen.

Figure 3 Study flow chart. ANP: Acute necrotising pancreatitis; WON: Walled off Necrosis; PCD: Percutaneous drainage; LAMS: Lumen apposing metallic stent.

Figure 4 Receiver operating characteristic curves for the multivariate predictive model and selected univariate predictors of necrosectomy. Hb: Hemoglobin; TLC: Total leucocyte count.