University of Colorado Anschutz Medical Campus Denver, CO
Mazin Al-Dujaili, MD1, Hayder Alamily, MD2, Omer Najem, MD3, Mohanad Albayyaa, MD4, Sana Rabeeah, MD5, Ban Mashadani, MD6, Bisher Sawaf, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Hasan Al-Obaidi, MD9, Osamah Alboawif, MBChB10, Umme Kulsum, MBBS11, Somaiya Ahmed, MBBS12, Irfat Islam Eva, MBBS13, Abu Sayed, MBBS14, Sunjida Amin Promi, MBBS15, Sajjad Al-Badri, MBChB16, Omar Saab, MD17 1St. John’s Episcopal Hospital, Far Rockaway, NY; 2University of Colorado Anschutz Medical Campus, Denver, CO; 3Department of internal medicine, Trinity Health Oakland, Pontiac, MI; 4Department of Internal Medicine, University of Texas Medical Branch, Houston, TX; 5The University of Toledo, Toledo, OH; 6Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; 7University of Toledo Medical Center, Toledo, OH; 8Jamaica Hospital Medical Center, Jamaica, NY; 9University of Toledo College of Medicine and Life Sciences, Toledo, OH; 10Wasit University College of Medicne, Kut, Wasit, Iraq; 11Rangpur Medical College, Rangpur, Rangpur, Bangladesh; 12Sir Salimullah Medical College (Mitford), Dhaka, Dhaka, Bangladesh; 13Comilla Medical College and Hospital, Comilla, Dhaka, Bangladesh; 14Chattogram Medical College, Chattogram, Dhaka, Bangladesh; 15Chattogram Medical College, Chittagram, Chittagong, Bangladesh; 16College of Medicine, University of Baghdad, Baghdad, Baghdad, Iraq; 17University of Texas Health Science Center, Houston, TX Introduction: Walled-off pancreatic necrosis (WON) is a late complication of acute necrotizing pancreatitis with significant morbidity and mortality. Traditional management with surgical necrosectomy (SN) is associated with considerable complications. Minimally invasive approaches, particularly endoscopic drainage (ED), have emerged as viable alternatives. This study compares clinical outcomes between ED and SN in a large cohort. Methods: We conducted a retrospective cohort study of 250 adults with radiologically confirmed WON treated with either ED or SN between January 2020 and December 2024 at a tertiary care center. Patients undergoing hybrid or percutaneous-only approaches were excluded. Primary outcomes included in-hospital mortality and new-onset organ failure within 30 days. Secondary outcomes included clinical success, adverse events, hospital stay duration, radiologic resolution, and quality of life (SF-36 at 6 months). Multivariate regression was used to adjust for confounders. Results: Among 250 patients (125 per group), baseline demographics and disease severity were similar. ED was associated with significantly lower mortality (6.4% vs. 12.0%, p=0.04) and new-onset organ failure (9.6% vs. 17.6%, p=0.03). Clinical success was higher with ED (84% vs. 76%, p=0.02), with fewer reinterventions (16% vs. 24%, p=0.04). ED had fewer complications including bleeding (8% vs. 20%, p< 0.01), infection (12% vs. 24%, p=0.01), and pancreatic fistula (2.4% vs. 9.6%, p=0.02). ED also resulted in shorter hospital stays (10.2 vs. 18.6 days, p< 0.01) and faster radiologic resolution (8.5 vs. 10.4 weeks, p=0.03). At 6 months, ED patients reported significantly better SF-36 scores across all domains. Discussion: Endoscopic drainage is associated with superior clinical outcomes compared to surgical necrosectomy in patients with WON, including lower mortality, fewer complications, shorter hospitalization, and better quality of life. These findings support ED as the preferred first-line approach in appropriately selected patients.
Figure: Endoscopic_Drainage_graphs
Disclosures: Mazin Al-Dujaili indicated no relevant financial relationships. Hayder Alamily indicated no relevant financial relationships. Omer Najem indicated no relevant financial relationships. Mohanad Albayyaa indicated no relevant financial relationships. Sana Rabeeah indicated no relevant financial relationships. Ban Mashadani indicated no relevant financial relationships. Bisher Sawaf indicated no relevant financial relationships. Mohannad Bitar indicated no relevant financial relationships. Mushfiqur Siddique indicated no relevant financial relationships. Hasan Al-Obaidi indicated no relevant financial relationships. Osamah Alboawif indicated no relevant financial relationships. Umme Kulsum indicated no relevant financial relationships. Somaiya Ahmed indicated no relevant financial relationships. Irfat Islam Eva indicated no relevant financial relationships. Abu Sayed indicated no relevant financial relationships. Sunjida Amin Promi indicated no relevant financial relationships. Sajjad Al-Badri indicated no relevant financial relationships. Omar Saab indicated no relevant financial relationships.
Mazin Al-Dujaili, MD1, Hayder Alamily, MD2, Omer Najem, MD3, Mohanad Albayyaa, MD4, Sana Rabeeah, MD5, Ban Mashadani, MD6, Bisher Sawaf, MD7, Mohannad Bitar, MD8, Mushfiqur Siddique, MD8, Hasan Al-Obaidi, MD9, Osamah Alboawif, MBChB10, Umme Kulsum, MBBS11, Somaiya Ahmed, MBBS12, Irfat Islam Eva, MBBS13, Abu Sayed, MBBS14, Sunjida Amin Promi, MBBS15, Sajjad Al-Badri, MBChB16, Omar Saab, MD17. P4372 - Endoscopic Drainage versus Surgical Necrosectomy in Walled-Off Pancreatic Necrosis: A Retrospective Cohort Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
