{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T08:10:20Z","timestamp":1778227820387,"version":"3.51.4"},"reference-count":9,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Key Laboratory Project of Digestive Diseases in Jiangxi Province","award":["2024SSY06101"],"award-info":[{"award-number":["2024SSY06101"]}]},{"name":"Jiangxi Clinical Research Center for Gastroenterology","award":["20223BCG74011"],"award-info":[{"award-number":["20223BCG74011"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In necrotizing pancreatitis, incomplete debridement of necrotic tissue can result in persistent infection. This case series describes use of an innovative chymotrypsin irrigation technique for treatment of walled-off necrosis (WON).<\/jats:p>\n                  <jats:p>Six patients with endoscopically non-accessible WON were treated with percutaneous catheter drainage (PCD) combined with chymotrypsin irrigation. In each session, 50 to 200 mL of a 120 U\/mL chymotrypsin solution was instilled via the drainage catheter, retained for 30 minutes, and then gently flushed with 0.9% sodium chloride. The procedure was repeated once daily until radiologic resolution of the necrotic cavity was achieved.<\/jats:p>\n                  <jats:p>WON was located in the pancreatic body\/tail (n = 4), involved the entire pancreas (n = 1), or was subphrenic (n = 1). All lesions measured \u2265 6 cm in maximum diameter (largest: 21\u00d710\u00d723 cm). Complete radiologic resolution of the necrotic cavity was achieved in all patients after a median irrigation duration of 7 days (range 4\u201321 days). In two cases where endoscopic debridement was also performed, the necrotic tissue was notably softened, facilitating the procedure. No severe complications occurred and all patients completed the treatment course.<\/jats:p>\n                  <jats:p>Chymotrypsin irrigation effectively liquefies fibrotic necrotic tissue and promotes WON clearance via PCD, representing a promising adjunctive therapy for managing endoscopically non accessible WON.<\/jats:p>","DOI":"10.1055\/a-2784-8824","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:17:50Z","timestamp":1770686270000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Efficacy of chymotrypsin irrigation for endoscopically non-accessible walled-off necrosis in necrotizing pancreatitis"],"prefix":"10.1055","volume":"14","author":[{"given":"Jianhua","family":"Wan","sequence":"first","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ximei","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No.1 People's Hospital, Jiujiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huajing","family":"Ke","sequence":"additional","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bingjun","family":"Yu","sequence":"additional","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nonghua","family":"Lu","sequence":"additional","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-1346","authenticated-orcid":false,"given":"Wenhua","family":"He","sequence":"additional","affiliation":[{"name":"Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1053\/j.gastro.2019.07.064","article-title":"American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis","volume":"158","author":"TH Baron","year":"2020","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute pancreatitis: A review","volume":"325","author":"MA Mederos","year":"2021","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011383.pub2","article-title":"Interventions for necrotising pancreatitis","volume":"4","author":"KS Gurusamy","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1016\/j.pan.2014.07.012","article-title":"Streptokinase may play role in expanding non-operative management of infected walled off pancreatic necrosis: preliminary results","volume":"14","author":"R Gupta","year":"2014","journal-title":"Pancreatology"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1016\/j.surg.2021.05.028","article-title":"Streptokinase irrigation through a percutaneous catheter helps decrease the need for necrosectomy and reduces mortality in necrotizing pancreatitis as part of a step-up approach","volume":"170","author":"V Bhargava","year":"2021","journal-title":"Surgery"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"4146","DOI":"10.1007\/s10620-021-07201-0","article-title":"Assessing the efficacy and outcomes following irrigation with streptokinase versus hydrogen peroxide in necrotizing pancreatitis: A randomized pilot study","volume":"67","author":"MV Bhargava","year":"2022","journal-title":"Dig Dis Sci"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/j.1365-2133.2010.09854.x","article-title":"Degradation of eschar from venous leg ulcers using a recombinant chymotrypsin from Lucilia sericata","volume":"163","author":"G Telford","year":"2010","journal-title":"Br J Dermatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s12325-017-0648-y","article-title":"The role of trypsin:chymotrypsin in tissue repair","volume":"35","author":"D Shah","year":"2018","journal-title":"Adv Ther"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ibmb.2015.11.012","article-title":"A Jonah-like chymotrypsin from the therapeutic maggot Lucilia sericata plays a role in wound debridement and coagulation","volume":"70","author":"AK P\u00f6ppel","year":"2016","journal-title":"Insect Biochem Mol Biol"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2784-8824.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:17:09Z","timestamp":1778224629000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2784-8824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":9,"journal-issue":{"issue":"CP","published-online":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026]]}},"alternative-id":["a27848824"],"URL":"https:\/\/doi.org\/10.1055\/a-2784-8824","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]}}}