RWON Study: The Real-World Walled-off Necrosis Study

• Published in: Clinical endoscopy Vol. 54; no. 6; pp. 909 - 915
• Main Authors: Ankush Pawar, Ujjwal Sonika, Manish Kumar, Sundeep Saluja, Siddharth Srivastava
• Format: Journal Article
• Language: Korean
• Published: 대한소화기내시경학회 30.11.2021
• Subjects: Drainage; Endoscopic ultrasound; Necrosis; Pancreatitis; Self-expandable metallic stent
• ISSN: 2234-2400

Background/Aims: The management of walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce. Methods: Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage (ED), or a combination of PCD and ED. We compared clinical outcome among these modalities. Results: A total of 264 patients were evaluated. The most common indications for drainage were pain and fever. Of the patients, 28% was treated with medical therapy alone, 31% with ED, 37% with PCD, and 4% with a combined approach. Technical success and clinical success were achieved in 93% and 91% of patients in the endoscopic arm and in 90% and 81% patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group. Conclusions: ED of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization. Clin Endosc 2021;54:909-915