ArticleSurgical endoscopy2026
Early versus late direct endoscopic necrosectomy for pancreatic walled-off necrosis: a grade‑assessed systematic review with trial sequential evidence.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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.
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal timing of direct endoscopic necrosectomy (DEN) for pancreatic walled-off necrosis (WON) remains uncertain, with practice varying from early intervention to a delayed approach. This systematic review and meta-analysis aims to compare the clinical efficacy and safety of early versus late DEN.
methodsWe systematically searched Cochrane, PubMed, Scopus, and Web of Science until October 28, 2025, for studies comparing early and late DEN. The primary outcomes were clinical success, technical success, the number of necrosectomy sessions, the need for percutaneous drainage, mortality, and procedure-related adverse events. Pooled estimates were calculated using random- or fixed-effects models and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Trial sequential analysis (TSA) was performed, and the certainty of evidence was evaluated. PROSPERO ID: CRD420251176766.
resultsEight studies were included, comprising three randomized controlled trials (RCTs) and five cohort studies, involving 745 patients. No significant differences were observed in clinical success (RR 1.04, 95% CI 0.99 to 1.09), technical success (RR 1.01, 95% CI 0.98 to 1.04), number of necrosectomy sessions (MD 0.35, 95% CI -0.50 to 1.19), mortality (RR 1.17, 95% CI 0.61 to 2.27), or overall adverse events (RR 0.91, 95% CI 0.68 to 1.22). TSA indicated firm evidence of no difference for clinical and technical success. In RCTs alone, early DEN was associated with a reduced need for percutaneous drainage (RR 0.44, 0.20 to 0.96). The certainty of evidence was rated as very low for most outcomes.
conclusionsEarly and late DEN show comparable efficacy and safety. Early DEN may reduce the need for adjunctive percutaneous drainage. However, the low certainty of evidence necessitates further high-quality RCTs to confirm these safety and efficiency findings.
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