Research: The Benefits of Immediate Endoscopic Interventions in Necrotizing Pancreatitis

Research led by Orlando Health Digestive Health Institute has determined that performing endoscopic necrosectomy at index treatment session significantly lowers the number of reinterventions and decreases length of hospital stay for patients with infected necrotizing pancreatitis. The institute collaborated with the University of Southern California, the University of West Virginia, RUSH University and the Asian Institute of Gastroenterology in India on the ground-breaking study.

The randomized trial of 70 patients compared immediate endoscopic necrosectomy versus step-up approach (stent placement followed by on-demand necrosectomy) to determine optimal interventional strategy in patients with infected necrotizing pancreatitis.

“Necrotizing pancreatitis carries mortality of 20% and requires invasive intervention,” says Shyam S. Varadarajulu, MD, president of Orlando Health Digestive Health Institute. “While transluminal stent placement followed by direct endoscopic necrosectomy when there is no clinical improvement is a common interventional strategy, the optimal timing to perform endoscopic debridement was previously unclear.”

Patients were divided into two groups and randomly assigned to receive either endoscopic necrosectomy at index treatment session after lumen-apposing metal stent placement or a step-up approach with necrosectomy performed only if there was no clinical improvement after stent placement. The trial ran from November 2019 to October 2022.

“This is the first study to do a comparison and reach definitive conclusions,” says Dr. Varadarajulu. “The clinical trial determined that treatment started the first day the stent is placed decreases the number of interventions with no increase to risk. Hospitalization was shortened, and patient outcomes improved.”  

A manuscript of the study is currently being drafted for a major journal. “Once published, we anticipate the findings will be incorporated into guidelines as the global standard of care,” says Dr. Varadarajulu.

Orlando Health Digestive Health Institute is a national and international destination for best-in-class clinical care and serves as a referral center of excellence, leading research and educational initiatives globally. The institute’s physicians lead numerous research initiatives on medical and endoscopic management of the most advanced gastrointestinal disorders, including pancreaticobiliary diseases, gastrointestinal cancers and inflammatory bowel disease.