ReviewSurgical endoscopy2026
Efficacy, safety, and cost of immediate versus on-demand endoscopic necrosectomy in infected necrotizing pancreatitis: a systematic review and meta-analysis.
Review 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.
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.
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Who cites it
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEndoscopic ultrasound (EUS)-guided drainage is the standard of care for walled-off necrosis (WON); however, the optimal timing of subsequent endoscopic necrosectomy remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate versus on-demand necrosectomy following EUS-guided drainage.
methodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library through March 2026 for RCTs comparing immediate (≤ 72 h) versus on-demand necrosectomy in adults with necrotizing pancreatitis. Primary outcomes were technical success, clinical success, and the proportion of patients undergoing necrosectomy. Secondary outcomes included length of hospital stay, costs, need for percutaneous or multigate drainage, and adverse events. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models.
resultsFour RCTs comprising 215 patients, of whom 192 (89.3%) had WON, were included. Immediate and on-demand approaches demonstrated similar technical success (RR 1.01, 95%CI 0.98-1.05) and clinical success (RR 1.17, 95%CI 0.98-1.40). Immediate necrosectomy was associated with a higher proportion of patients undergoing necrosectomy (RR 1.65, 95%CI 1.13-2.41). No significant differences were observed in length of hospital stay, costs, need for additional drainage, procedure- or disease-related adverse events, mortality, bleeding, stent migration, or pneumoperitoneum.
conclusionsImmediate endoscopic necrosectomy did not demonstrate a consistent clinical advantage over an on-demand approach. Low- to very-low-certainty evidence suggests little or no difference in clinical efficacy or safety outcomes, while very-low-certainty evidence suggests that immediate necrosectomy may increase the proportion of patients undergoing necrosectomy. However, the magnitude and clinical significance of this effect remain uncertain. These findings should be interpreted cautiously given the limited number of randomized trials, modest sample sizes, and low or very low certainty of evidence for several outcomes.
trial registrationThis study was prospectively registered in PROSPERO (CRD420261366884).
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