Endoscopic management of necrotizing pancreatitis within a multidisciplinary framework: a single-center retrospective study

Abstract

Endoscopic step-up strategies for necrotizing pancreatitis are poorly documented in multidisciplinary real-world clinical practice. This study evaluated the feasibility and clinical outcomes of an endoscopic management strategy within a structured multidisciplinary framework for patients with necrotizing pancreatitis. Methods: This retrospective, single-center study evaluated 13 consecutive patients with necrotizing pancreatitis who underwent endoscopic treatment between January 2022 and December 2025. Demographic characteristics, disease severity via the Modified Computed Tomography Severity Index (MCTSI), details of endoscopic interventions, microbiological findings, and clinical outcomes were analyzed. Results: The median disease severity score was 8 (range, 4–10). Patients underwent a median of 6 (range, 2–15) endoscopic interventions, with the initial intervention performed at a median of 18 days (range, 1–90) from diagnosis. The median follow-up duration was 7 months (range, 1–41). Lumen-apposing metal stents followed by coaxial plastic pigtail stents were utilized in most patients. Microbiological cultures predominantly revealed Candida spp. and Klebsiella pneumoniae, including multidrug-resistant organisms in a subset. The median hospital stay was 21 days (range, 8–97), and the median intensive care unit (ICU) stay was 0 days (range, 0–44). No in-hospital mortality was observed; long-term complications occurred in a minority of patients. Conclusions: Endoscopic management within a structured multidisciplinary framework is a feasible and safe treatment strategy for necrotizing pancreatitis. Given the limited sample size, larger prospective studies are warranted to validate these findings.