Evidence map›Paper›PMID 42414778›Full record

SynthesisSurgical endoscopy2026

SAGES systematic review and meta-analysis for the management of symptomatic walled-off pancreatic necrosis.

Olivia Ganescu, Elisa C Calabrese, Himsikhar Khataniar, Pramod Nepal, Claire Wunker, Dena Shehata, Ahmed Abou-Setta, Ivan D Florez, Bethany J Slater, Kevin El-Hayek

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Olivia GanescuDivision of General Surgery, McGill University Health Centre, Montreal, QC, Canada.
Elisa C CalabreseDepartment of Surgery, University of California-East Bay, Oakland, CA, USA. eclbrs@gmail.com.ORCID http://orcid.org/0009-0007-0217-7933
Himsikhar KhataniarDepartment of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
Pramod NepalDepartment of Surgery, Henry Ford St. John Hospital, Detroit, MI, USA.
Claire WunkerDepartment of Surgery, University of Michigan, Ann Arbor, MI, USA.
Dena ShehataDepartment of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
Ahmed Abou-SettaDepartment of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Ivan D FlorezDepartment of Pediatrics, University of Antioquia, Medellin, Colombia.
Bethany J SlaterDepartment of Surgery, Mount Sinai Kravis Children's Hospital, New York, NY, USA.
Kevin El-HayekDepartment of Surgery, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOptimal management of symptomatic walled-off pancreatic necrosis (WOPN) continues to evolve, yet current guidelines provide limited direction across treatment options. This systematic review and meta-analysis compared WOPN interventions to inform forthcoming clinical guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

methodsA systematic review through January 24, 2025, addressed four key questions (KQs): (1) image-guided versus endoscopic, (2) image-guided versus surgical, (3) endoscopic versus surgical, and (4) pure endoscopic versus the step-up approaches. Randomized controlled trials (RCTs) and comparative observational studies were included. Meta-analyses used random-effects models. Certainty of evidence (CoE) was assessed using GRADE. Reporting followed PRISMA 2020.

resultsCompared to endoscopic (KQ1), image-guided intervention may be associated with higher mortality (OR: 4.80), increased combined and surgical reintervention (OR: 3.94), more severe complications (OR: 5.42), and longer hospital stay (OR: 15.75). Compared to open surgery (KQ2), image-guided intervention may be associated with lower mortality (OR: 0.40) and fewer radiologic reinterventions (OR: 0.14), but higher surgical reintervention (OR: 4.28). No significant differences were observed compared with minimally invasive surgery (MIS). In RCT data, endoscopic and MIS approaches (KQ3) may have similar outcomes, with no significant differences in mortality, complications, or reintervention. For pure endoscopic vs step-up approaches (KQ4), RCT data suggest that an endoscopic-only strategy may be associated with fewer severe complications (OR: 0.36) but higher rates of radiologic (OR: 4.48) and endoscopic reinterventions (OR: 2.96), with no clear difference in mortality.

conclusionEndoscopic management may be associated with more favorable outcomes than image-guided interventions. Image-guided intervention may be associated with lower mortality than open surgery but increased surgical reintervention. Endoscopic and MIS approaches may be equally effective. Endoscopic-only approaches may reduce severe complications at the cost of more reinterventions than the step-up approach. Overall, CoE is very low, highlighting the need for high-quality, multicenter RCTs.

Indexed as

Pancreatitis, Acute NecrotizingDrainageHumansSurgery, Computer-AssistedImage-guided interventionMinimally invasive surgeryOpen surgical debridement and drainagePercutaneous-guided interventionWalled-off pancreatic necrosis

Identifiers

PMID42414778

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.