Upfront Endoscopic Necrosectomy Versus Step-Up Endoscopic Approach for Walled-off Pancreatic Necrosis: A systematic review and meta-analysis
Recommended Citation
Tazinkeng N, Elmustafa F, Liao K, Dele D, Mapouka M, Suhail N, Reategui-Almonacid Y, Lubin N, Igbinedion S. Upfront Endoscopic Necrosectomy Versus Step-Up Endoscopic Approach for Walled-off Pancreatic Necrosis: A systematic review and meta-analysis. Gastrointest Endosc. 2026.
Document Type
Article
Publication Date
3-3-2026
Publication Title
Gastrointestinal endoscopy
Abstract
BACKGROUND AND AIMS: Endoscopic necrosectomy has emerged as the preferred method for managing walled-off pancreatic necrosis. Despite the growing adoption of endoscopic techniques, there is limited comparative data with large sample sizes to guide optimal timing and sequencing of interventions. This systematic review evaluated the efficacy and safety of Upfront Endoscopic Necrosectomy (UEN) compared to Step-up Endoscopic Necrosectomy (SUEN) in patients with walled off pancreatic necrosis.
METHODS: Following the PRISMA guidelines, we conducted a comprehensive search on MEDLINE, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials and Clinicaltrials.gov, for articles published from inception of the databases to February 20, 2025. Random-effects meta-analytic models were used to calculate pooled relative risks (RR) or standardized mean differences (SMD) and their 95% confidence intervals (CI) for dichotomous and numerical variables respectively. Heterogeneity across studies was assessed using the I(2) statistic and Cochran's Q test.
RESULTS: We included five studies with a total sample size of 548 participants (55.9% male and 44.1% female). Most of the included studies were retrospective comparative cohort analysis (4/5), and conducted in the USA (4/5). The mean age of participants was 51.74 ± 15.4 years in the UEN group and 53.2 ± 18.0 years in the SUEN group. In terms of efficacy outcomes, we found no significant differences in clinical success (RR: 1.04, 95% CI: 0.98 - 1.11), technical success (RR 1.27, 95% CI: 0.86 - 1.870), length of hospital stay (SMD -0.03, 95% CI: -0.61 - 0.54), and number of interventions required to achieve clinical success (SMD: -0.04, 95% CI: -0.65, 0.57), in patients receiving UEN compared to the SUEN group. Similarly, there were no significant differences in safety outcomes such as post-procedural bleeding (RR 0.66, 95% CI: 0.34, 1.30), post-procedural infection (RR 1.06, 95% CI 0.40, 2.85), stent migration (RR 0.46, 95% CI: 0.14 - 1.54), stent occlusion (RR 0.42, 95% CI 0.17 - 1.04), recurrence (RR 0.71, 95% CI: 0.31 - 1.62) or post-procedure mortality (RR 1.19, 95% CI: 0.48 - 2.97) between both groups.
CONCLUSION: Our study demonstrates that UEN and SUEN perform similarly in terms of commonly measured efficacy and safety endpoints. This finding underscores the importance of individualized approach in the treatment of patients with walled-off pancreatic necrosis.
PubMed ID
41786153
ePublication
ePub ahead of print
