Necrosis extent and QNI classification predict step-up needs.

A study of seventy patients undergoing EUS-guided drainage revealed that 35.7% required step-up procedures, mainly endoscopic necrosectomy. Independent predictors included necrosis ≥60% and classification in the high-risk Quadrant Necrosis Infection (QNI) group. Clinical success was high, at 92.9%, with those in the high-risk group experiencing longer hospital stays. EUS evaluations showed a tendency to overestimate necrosis compared to preprocedural radiology, highlighting the importance of personalized treatment approaches in managing peripancreatic fluid collections.