Endoscopic Necrosectomy for Infected Walled-off Pancreatic Necrosis: A Systematic Review and Meta-Analysis

Aim: to evaluate the clinical success and complication rates of endoscopic step-up necrosectomy in patients with infected walled-off pancreatic necrosis, based on an analysis of contemporary scientific publications.

Material and methods. A systematic review and meta-analysis of 15 studies (total of 869 patients) published since 2020 and conforming to current treatment standards was conducted. The inclusion criteria were peer-reviewed original articles in Russian or English focusing on endoscopic step-up necrosectomy via a transluminally placed metal stent with a diameter greater than 1 cm in patients with confirmed infected walled-off pancreatic necrosis. A random-effects model was used for meta-analysis.

Results. The weighted mean clinical success rate of endoscopic step-up necrosectomy was 89.5 % (95% confidence interval (CI): 87.5–92.1 %). Considerable variability in outcomes was observed between studies (range: 61 to100%), with significant heterogeneity (I2= 89.2 %). The mean complication rate was 18.8 % (95% CI: 12.5–25.1%).The most frequent complications were stent migration (5.2 %), bleeding (3.9 %), and stent obstruction (2.1 %). The analysis revealed significant variability in the criteria used to define clinical success across the studies.

Conclusions. Endoscopic step-up necrosectomy is a highly effective treatment for infected walled-off pancreatic necrosis with an acceptable safety profile. However, the lack of unified, standardized criteria for clinical success and the high heterogeneity of the data complicate comparative analysis. To improve the quality of evidence, it is necessary to develop standardized definitions of success and complications, as well as to conduct randomized controlled trials.

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