{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:13:34Z","timestamp":1779358414638,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"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\/Objectives: Acute infected necrotizing pancreatitis remains associated with substantial morbidity and mortality. The step-up approach combines minimal-invasive drainage with endoscopic transgastric or percutaneous necrosectomy and has been shown to improve outcomes compared with open surgery. Laparoscopic-assisted necrosectomy (LAPN) may be performed in cases of infected walled-off necrosis (WON) following percutaneous drainage and is typically carried out using laparoscopic instrumentation. A newly implemented interdisciplinary approach includes sinus tract endoscopy, guided necrosectomy (STEN), which employs flexible endoscopy through a surgically created sinus tract and offers a less invasive and more targeted alternative to LAPN, providing improved visualization of complex necrotic cavities and facilitating repeatable step-up debridement. This study aimed to assess the introduction of STEN compared with LAPN in the management of infected WON within a step-up approach. Methods: A retrospective analysis of patients with infected walled-off necrosis (WON) treated using a step-up approach between 2019 and 2025 was conducted. Patients who underwent CT-guided percutaneous drainage followed by either STEN or LAPN were included. Demographic characteristics and clinical outcomes were collected. The primary endpoint was a composite outcome comprising major complications and 6-month mortality. Secondary outcomes included overall complication rates, need for reinterventions, and length of hospital stay. Results: During the study period, 17 patients were included. All patients were managed using a step-up approach: nine underwent STEN and eight underwent LAPN. In the STEN group, six patients (66.7%) met the primary endpoint, all due to major complications, with no mortality observed. In the LAPN group, the primary endpoint occurred in four patients (50.0%), including one death and three major complications. Conclusions: Our study showed that both STEN and LAPN were effective in treating infected WON within a step-up approach. STEN and LAPN showed comparable outcomes. However, these findings should be interpreted as exploratory and with caution given the retrospective design and the small sample size of this study. Further studies with larger patient cohorts are warranted to confirm these findings and to better define the role of this technique in the management of infected necrotizing pancreatitis.<\/jats:p>","DOI":"10.3390\/jcm15103694","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"3694","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interdisciplinary Step-Up Strategy for Infected Pancreatic Walled-Off Necrosis: Sinus Tract Endoscopic Necrosectomy (STEN) Versus Laparoscopic-Assisted Necrosectomy (LAPN)"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5891-4839","authenticated-orcid":false,"given":"Valerie","family":"Kremo","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9539-7626","authenticated-orcid":false,"given":"Julia","family":"M\u00fchlh\u00e4usser","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"},{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna","family":"Plazer","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4279-2574","authenticated-orcid":false,"given":"Andreas","family":"Scheiwiller","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Baumeler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"B\u00fctikofer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Bolli","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Mongelli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Via Gallino, 6500 Bellinzona, Switzerland"},{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, Via la Santa 1, 6900 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rn-Markus","family":"Gass","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland"},{"name":"Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11605-018-3908-5","article-title":"Minimally Invasive Debridement for Infected Pancreatic Necrosis","volume":"23","author":"Fong","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1056\/NEJMoa0908821","article-title":"A step-up approach or open necrosectomy for necrotizing pancreatitis","volume":"362","author":"Besselink","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1053\/j.gastro.2024.02.052","article-title":"Diagnosis and Management of Acute Pancreatitis","volume":"167","author":"Trikudanathan","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1001\/jama.2012.276","article-title":"Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: A randomized trial","volume":"307","author":"Bakker","year":"2012","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1080\/13651820701225688","article-title":"Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis","volume":"9","author":"Besselink","year":"2007","journal-title":"HPB"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.pan.2021.11.011","article-title":"Cost-effectiveness analysis of infected necrotizing pancreatitis management in an academic setting","volume":"22","author":"Prasath","year":"2022","journal-title":"Pancreatology"},{"key":"ref_7","first-page":"e481","article-title":"Episodic and Long-Term Costs of Acute Pancreatitis Requiring Hospitalization among Adults in US Clinical Practice","volume":"55","author":"Soffer","year":"2025","journal-title":"Pancreas"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4459","DOI":"10.1177\/00031348221101495","article-title":"Laparoscopic-Assisted Pancreatic Necrosectomy: Technique and Initial Outcomes","volume":"89","author":"Eng","year":"2023","journal-title":"Am. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.giec.2023.04.011","article-title":"Percutaneous Endoscopic Necrosectomy","volume":"33","author":"Mahapatra","year":"2023","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"731","DOI":"10.4240\/wjgs.v14.i8.731","article-title":"Percutaneous direct endoscopic pancreatic necrosectomy","volume":"14","author":"Vyawahare","year":"2022","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1001\/jamasurg.2022.5695","article-title":"Contemporary Surgical Management of Pancreatic Necrosis","volume":"158","author":"Maurer","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20132012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s00423-025-03872-9","article-title":"Minimal-invasive percutaneous step-up approach compared to endoscopic procedures in the treatment of walled off pancreatic necrosis: A retrospective study","volume":"410","author":"Kremo","year":"2025","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","article-title":"The comprehensive complication index: A novel continuous scale to measure surgical morbidity","volume":"258","author":"Slankamenac","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E258","DOI":"10.1055\/a-1935-4738","article-title":"Percutaneous endoscopic necrosectomy (PEN) for treatment of necrotizing pancreatitis: A systematic review and meta-analysis","volume":"11","author":"Gjeorgjievski","year":"2023","journal-title":"Endosc. Int. Open"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jagielski, M., Chwarscianek, A., Dudek, D., Piatkowski, J., and Jackowski, M. (2026). Percutaneous Endoscopic Necrosectomy of Walled-Off Pancreatic and Peripancreatic Necrosis. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020470"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5736","DOI":"10.12998\/wjcc.v11.i24.5736","article-title":"Percutaneous endoscopic necrosectomy for walled-off necrosis in the retroperitoneal space of the elderly: A case report","volume":"11","author":"Sato","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"279","DOI":"10.5946\/ce.2017.066","article-title":"Pancreatic Necrosectomy through Sinus Tract Endoscopy","volume":"51","author":"Goenka","year":"2018","journal-title":"Clin. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/00000658-200008000-00004","article-title":"Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: An initial experience","volume":"232","author":"Carter","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.gie.2025.08.002","article-title":"Percutaneous sinus tract endoscopic necrosectomy: Double-lumen catheters may be more economical and equally safe compared with fully covered metal stents","volume":"103","author":"Wu","year":"2026","journal-title":"Gastrointest. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3245","DOI":"10.1007\/s00464-026-12587-x","article-title":"Serial percutaneous endoscopic necrosectomy (SPEN) after initial VARD for necrotizing pancreatitis: A retrospective single-center observational study","volume":"40","author":"Palzer","year":"2026","journal-title":"Surg. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1007\/s00464-013-3382-9","article-title":"Endoscopic transluminal necrosectomy in necrotising pancreatitis: A systematic review","volume":"28","author":"Fockens","year":"2014","journal-title":"Surg. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3694\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:00:53Z","timestamp":1779357653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":23,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103694"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103694","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}