Endoscopic necrosectomy of pancreatic necrosis: a systematic review

To review the current status of the novel technique of endoscopic necrosectomy in the management of pancreatic necrosis after acute pancreatitis. Studies were identified by searching Medline, PubMed and Embase databases for articles from January 1990 to December 2009 using the keywords acute pancreatitis, pancreatic necrosis and endoscopy. Additional papers were identified by a manual search of the references from the key articles. Case series of fewer than five patients and case reports were excluded. Indications, techniques and outcomes of endoscopic necrosectomy were analysed. There were no randomised controlled trials identified. Ten case series were included in this analysis. There were a total of more than 1,100 endoscopic necrosectomy procedures in 260 patients with pancreatic necrosis. One hundred fifty-five were proven to be infected necrosis on culture. The overall mortality rate was 5%. The mean procedure-related morbidity rate was 27%. The rate of complete resolution of pancreatic necrosis with the endoscopic method alone was 76%. Endoscopic necrosectomy is a safe and effective treatment option in selected patients with pancreatic necrosis after acute pancreatitis. Future studies will be required to further define the selection criteria and the techniques for the endoscopic procedure.