{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:56:56Z","timestamp":1790603816440,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal timing of direct endoscopic necrosectomy (DEN) for Necrotizing Pancreatitis (NP) remains unclear. This meta\u2010analysis aimed to evaluate the efficacy and safety of immediate DEN compared with on\u2010demand DEN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify studies. The primary outcome measure was clinical success.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven studies (4 RCTs and 3 observational studies) comprising 616 patients were included. Immediate DEN did not demonstrate a statistically significant advantage in clinical success (OR: 1.92, 95% CI 1.01\u20133.63). No significant differences were found in technical success (OR: 1.62, 95% CI: 0.43\u20136.09), total number of DEN (standardized mean difference: 0.31, 95% CI: \u22120.21\u20130.84), need for additional percutaneous drainage (OR: 0.53, 95% CI: 0.27\u20131.03), need for salvage surgery (OR: 0.60, 95% CI: 0.28\u20131.27), procedure\u2010related adverse events were comparable between groups (OR: 0.81, 95% CI: 0.51\u20131.28), disease\u2010related adverse events (OR: 0.84, 95% CI: 0.34\u20132.13), mortality (OR: 1.11, 95% CI: 0.47\u20132.59). In RCT\u2010only analyses, these findings remained consistent. Immediate DEN lowered stent migration risk (OR: 0.31, 95% CI: 0.11\u20130.92), but lost significance in RCT\u2010only analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta\u2010analysis found no overall superiority of immediate DEN over on\u2010demand DEN for patients with NP, highlighting the need to identify specific subgroups that benefit from an upfront necrosectomy strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ueg2.70290","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:45:33Z","timestamp":1788237933000},"source":"Crossref","is-referenced-by-count":0,"title":["Immediate Versus On\u2010Demand Direct Endoscopic Necrosectomy for Necrotizing Pancreatitis: A Systematic Review and 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