After EUS-guided drainage for infected necrotizing pancreatitis, immediate necrosectomy showed no clear clinical advantage over waiting to intervene as needed—and may expose more patients to the procedure.
- Across 4 randomized trials (215 patients), clinical success was similar (RR 1.17, 95% CI 0.98–1.40); hospital stay, costs, complications, and mortality also did not differ significantly.
- Immediate treatment increased the proportion undergoing necrosectomy (RR 1.65, 95% CI 1.13–2.41).
The evidence is low to very low certainty, so this supports an on-demand option—not a definitive change in practice.
Review by Al Hayek M, Sawaf B (…) Al-Haddad M et 5 al. in Surg Endosc
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