{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:42:27Z","timestamp":1779291747953,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Minimally invasive approaches for managing complications of acute necrotizing pancreatitis have advanced significantly in recent decades. When extensive walled-off pancreatic or peripancreatic necrosis is present, a single transluminal access may be insufficient. This study aimed to prospectively evaluate the effectiveness and safety of a novel percutaneous endoscopic necrosectomy technique used as an adjunct to transmural drainage in patients with symptomatic walled-off necrosis. Methods: A total of 513 consecutive patients with symptomatic walled-off pancreatic or peripancreatic necrosis treated between 2018 and 2025 at a single tertiary center in Poland were included. All patients underwent minimally invasive endoscopic management. Among them, a subgroup required additional percutaneous drainage. The innovative technique involved creating retroperitoneal percutaneous access to the necrotic cavity, enlarging the tract, and placing a self-expanding metal stent to allow passage of the endoscope for percutaneous endoscopic necrosectomy. Results: Additional percutaneous drainage was necessary in 39\/513 patients (7.6%). Of these, 9\/39 (23.1%) patients (2 women, 7 men; mean age 46.7 years) underwent percuaneous endoscopic necrosectomy. The mean size of the necrotic collection was 25.96 cm. Active percutaneous drainage during ongoing transmural endotherapy lasted a median of 15 days. Patients underwent an average of 3.12 necrosectomy sessions. Treatment-related complications occurred in 2\/9 patients (22.22%). Clinical and long-term success were each achieved in 8\/9 patients (88.89%). Conclusions: Percutaneous endoscopic necrosectomy is a promising minimally invasive therapeutic option for extensive walled-off pancreatic and peripancreatic necrosis, particularly when necrosis extends into the pelvic region. However, clinical evidence remains limited and further studies are needed.<\/jats:p>","DOI":"10.3390\/jcm15020470","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:34:21Z","timestamp":1767789261000},"page":"470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Percutaneous Endoscopic Necrosectomy of Walled-Off Pancreatic and Peripancreatic Necrosis"],"prefix":"10.3390","volume":"15","author":[{"given":"Mateusz","family":"Jagielski","sequence":"first","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Regional Hospital, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2451-2076","authenticated-orcid":false,"given":"Agata","family":"Chwar\u015bcianek","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Regional Hospital, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2451-6250","authenticated-orcid":false,"given":"Damian","family":"Dudek","sequence":"additional","affiliation":[{"name":"Department of Perioperative Dentistry, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4776-664X","authenticated-orcid":false,"given":"Jacek","family":"Pi\u0105tkowski","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Regional Hospital, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marek","family":"Jackowski","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Ludwik Rydygier Regional Hospital, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.pan.2016.07.004","article-title":"Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis","volume":"16","author":"Werge","year":"2016","journal-title":"Pancreatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/tgh-2020-08","article-title":"Management of severe acute pancreatitis in 2019","volume":"7","author":"Copelin","year":"2022","journal-title":"Transl. 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