Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.

We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.

A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2–5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3%). Snares were used in most procedures (90.9%), EndoRotor in 4.3%, and both were used in 4.8% of procedures. A total of 14 AEs (1.6%) were identified in 11 different patients (4.7%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5%) than in the non-AE group (10.3%, P = 0.0004).

AEs are rare in EN but are associated with increased mortality.

Received: 01 June 2025

Accepted after revision: 28 October 2025

Accepted Manuscript online:
04 November 2025

Article published online:
26 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Julie Falkebo Jensen, Joy Stinne Timmner, Amer Hadi, Erik Feldager, August Pilegaard Prahm, Mohamed Ebrahim, Gitte Aabye Olsen, Stine Roug, Srdan Novovic, John Gásdal Karstensen. Endoscopic necrosectomy is safe in patients with pancreatic walled-off necrosis: Insights from a tertiary center study of 880 procedures. Endosc Int Open 2025; 13: a27376307.
DOI: 10.1055/a-2737-6307