A systematic review finds no significant difference in outcomes between upfront endoscopic necrosectomy (UEN) and step-up endoscopic necrosectomy (SUEN) for walled-off pancreatic necrosis, influencing surgical decision-making.

• Clinical success rates were similar: RR 1.04 (95% CI, 0.98-1.11).
• Safety outcomes, including postprocedural bleeding and infection, also showed no significant differences.

Surgeons should consider individual patient factors when choosing between UEN and SUEN, as both approaches yield comparable results.