{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:56:18Z","timestamp":1788353778421,"version":"build-2803163510"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"12","funder":[{"DOI":"10.13039\/100018254","name":"Japanese Foundation for Research and Promotion of Endoscopy","doi-asserted-by":"crossref","award":["B\/#1015"],"award-info":[{"award-number":["B\/#1015"]}],"id":[{"id":"10.13039\/100018254","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>There is no consensus regarding the optimal timing of endoscopic ultrasound (EUS)-guided interventions for walled-off necrosis (WON) secondary to acute pancreatitis. Currently, intervention timing is primarily determined by the duration after the onset of acute pancreatitis, which potentially serves as a surrogate for fluid collection maturation. We hypothesized that the encapsulation status may be more strongly correlated with clinical outcomes.<\/jats:p>\n                  <jats:p>Between January 2010 and November 2020, 222 patients who underwent EUS-guided WON treatment at 11 centers of the WONDERFUL consortium were included. The patients were divided into two groups based on their encapsulation status at drainage (partial\/no vs. complete). The clinical outcomes were compared between groups.<\/jats:p>\n                  <jats:p>Technical success rates were similar between the groups. Complete encapsulation was\n        associated with a higher clinical success rate (88.1% vs. 52.2%; P&lt;0.001). When patients were classified by both time elapsed and\n        encapsulation status, the encapsulation status was more strongly associated with clinical\n        success. Complete encapsulation was associated with a lower overall adverse event rate\n        (22.7% vs. 39.1%; P=0.04). Overall mortality was significantly\n        higher in the partial\/no encapsulation group (34.8% vs. 3.4%; P\n       &lt;0.001). In multivariable analysis, the encapsulation status and diameter of the WON\n        were identified as significant factors associated with clinical success.<\/jats:p>\n                  <jats:p>In patients undergoing EUS-guided WON treatment, the encapsulation status, rather than the time elapsed since disease onset, appeared to be more strongly associated with positive clinical outcomes.<\/jats:p>","DOI":"10.1055\/a-2654-4317","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T22:32:07Z","timestamp":1752359527000},"page":"1355-1364","source":"Crossref","is-referenced-by-count":7,"title":["Encapsulation levels rather than elapsed time after the onset of acute pancreatitis are related to clinical outcomes of pancreatic walled-off necrosis"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2166-715X","authenticated-orcid":false,"given":"Akinori","family":"Maruta","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-1787","authenticated-orcid":false,"given":"Takuji","family":"Iwashita","sequence":"first","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6008-1648","authenticated-orcid":false,"given":"Tomotaka","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Gonoi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensaku","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7291-3608","authenticated-orcid":false,"given":"Shunsuke","family":"Omoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7308-4311","authenticated-orcid":false,"given":"Mamoru","family":"Takenaka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Tsujimae","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuhiro","family":"Masuda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Hamada","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"},{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Uemura","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5171-1847","authenticated-orcid":false,"given":"Shogo","family":"Ota","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Suda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8182-3524","authenticated-orcid":false,"given":"Saburo","family":"Matsubara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7367-0767","authenticated-orcid":false,"given":"Toshio","family":"Fujisawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhei","family":"Iwasa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Iwata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiko","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, University of Toyama, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Mukai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6206-9236","authenticated-orcid":false,"given":"Hiroyuki","family":"Isayama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Yasuda","sequence":"additional","affiliation":[{"name":"Third Department of Internal Medicine, University of Toyama, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuke","family":"Nakai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"},{"name":"Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women\u2019s Medical University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the WONDERFUL study 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walled-off pancreatic necrosis","volume":"33","author":"I Yasuda","year":"2021","journal-title":"Dig Endosc"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1055\/a-0588-5365","article-title":"Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines","volume":"50","author":"M Arvanitakis","year":"2018","journal-title":"Endoscopy"},{"issue":"S 02","key":"ref8","first-page":"e1","article-title":"IAP\/APA evidence-based guidelines for the management of acute pancreatitis","volume":"13","author":"Working Group IAP\/APA Acute Pancreatitis Guidelines","year":"2013","journal-title":"Pancreatology"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s00535-022-01935-y","article-title":"Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future 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Gastroenterol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00464-023-10568-y","article-title":"Early versus delayed EUS-guided drainage for postoperative pancreatic fluid collections: a systematic review and meta-analysis","volume":"38","author":"T Mukai","year":"2024","journal-title":"Surg Endosc"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1002\/deo2.171","article-title":"Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta-analysis","volume":"3","author":"Y Nakai","year":"2023","journal-title":"DEN Open"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.gie.2022.11.003","article-title":"Early (<4 weeks) versus standard (\u22654 weeks) endoscopic drainage of pancreatic\n          walled-off fluid collections: a systematic review and meta-analysis","volume":"97","author":"D Ramai","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1056\/NEJMoa2100826","article-title":"Immediate versus postponed intervention for infected necrotizing pancreatitis","volume":"385","author":"L Boxhoorn","year":"2021","journal-title":"NEJM"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/den.14924","article-title":"Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Multicenter study with nationwide data-based validation","volume":"37","author":"T Hamada","year":"2025","journal-title":"Dig Endosc"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/SLA.0000000000001203","article-title":"Predicting success of catheter drainage in infected necrotizing pancreatitis","volume":"263","author":"RA Hollemans","year":"2016","journal-title":"Ann 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Mallick","year":"2018","journal-title":"Pancreatology"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3390\/diagnostics14040381","article-title":"Indications, techniques and future perspectives of walled-off necrosis management","volume":"14","author":"E Troncone","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1001\/archsurg.142.12.1194","article-title":"Timing of surgical intervention in necrotizing pancreatitis","volume":"142","author":"MG Besselink","year":"2007","journal-title":"Arch Surg"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.cgh.2022.06.016","article-title":"Current controversies and challenges in endoscopic management of necrotizing pancreatitis","volume":"20","author":"G Trikudanathan","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref31","first-page":"463","article-title":"Wall maturation in necrotic collections in acute pancreatitis: a computed tomography based evaluation","volume":"85","author":"SR Choudhury","year":"2022","journal-title":"Acta Gastroenterol Belg"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1007\/s11605-018-3792-z","article-title":"Natural history of gas configurations and encapsulation in necrotic collections during necrotizing pancreatitis","volume":"22","author":"J van Grinsven","year":"2018","journal-title":"J Gastrointest Surg"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12876-024-03145-7","article-title":"Early encapsulation of peripancreatic fluid\/necrosis collections on imaging (CECT) in acute pancreatitis: influential factors and clinical significance for prognosis","volume":"24","author":"N Ning","year":"2024","journal-title":"BMC Gastroenterol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/den.14598","article-title":"Time to think prime times for treatment of necrotizing pancreatitis: Pendulum conundrum","volume":"35","author":"Y Nakai","year":"2023","journal-title":"Dig Endosc"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1053\/j.gastro.2011.06.073","article-title":"A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome","volume":"141","author":"HC van 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