Upfront endoscopic necrosectomy (UEN) and step-up endoscopic necrosectomy (SUEN) show similar outcomes for walled-off pancreatic necrosis, impacting how you approach patient management.

• No significant difference in clinical success (RR: 1.04) or technical success (RR: 1.27) between UEN and SUEN.
• Patient safety outcomes, including post-procedural bleeding (RR: 0.66) and recurrence (RR: 0.71), were comparable.

Individualized treatment strategies remain crucial in optimizing patient outcomes.

• Average length of hospital stay was nearly identical (SMD: -0.03).