Surgical endoscopy · 2026
SAGES clinical practice guidelines for the management of symptomatic walled-off pancreatic necrosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Calabrese Elisa C, Shehata Dena, Slater Bethany J, Palazzo Francesco, Alseidi Adnan, Sun James, Onkendi Edwin, Molina David Caba, Mallette Katlin, Ricker Ansley B, Ayloo Subhashini, Lyons Joshua, Maddern Guy, Oviedo Rodolfo J, Elhadi Muhammed, Kchaou Ali, Shaikh Saamia, Maegawa Felipe B, Catanzaro Andrew, Shlansky-Goldberg Richard D, Cleary Sean, Florez Ivan D, El-Hayek Kevin
Аннотация
BACKGROUND: Walled-off pancreatic necrosis (WOPN) is a serious sequela following acute pancreatitis with significant associated morbidity and mortality. These guidelines provide best practice recommendations for the management of this complication.
METHODOLOGY: A systematic review was conducted, including a literature search from 1/1/2020 to 1/24/2025, addressing four key questions regarding the management of WOPN in adults. The findings were subsequently presented to a multidisciplinary panel of surgeons, gastroenterologists, and interventional radiologists, including those from both the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Americas Hepato-Pancreato-Biliary Association (AHPBA). The GRADE methodology was then used to develop evidence-based recommendations.
RESULTS: All recommendations were based on very low certainty of evidence. A conditional recommendation was made for endoscopic management versus image-guided intervention. A conditional recommendation was made for image-guided intervention versus open surgery. A conditional recommendation was made for either minimally invasive surgery or image-guided intervention. A conditional recommendation was made for minimally invasive surgery versus endoscopic intervention. A conditional recommendation was made for either a pure endoscopic approach versus a step-up approach.
CONCLUSIONS: These recommendations provide guidance for the approach to the management of WOPN according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base regarding the treatment of WOPN.
METHODOLOGY: A systematic review was conducted, including a literature search from 1/1/2020 to 1/24/2025, addressing four key questions regarding the management of WOPN in adults. The findings were subsequently presented to a multidisciplinary panel of surgeons, gastroenterologists, and interventional radiologists, including those from both the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Americas Hepato-Pancreato-Biliary Association (AHPBA). The GRADE methodology was then used to develop evidence-based recommendations.
RESULTS: All recommendations were based on very low certainty of evidence. A conditional recommendation was made for endoscopic management versus image-guided intervention. A conditional recommendation was made for image-guided intervention versus open surgery. A conditional recommendation was made for either minimally invasive surgery or image-guided intervention. A conditional recommendation was made for minimally invasive surgery versus endoscopic intervention. A conditional recommendation was made for either a pure endoscopic approach versus a step-up approach.
CONCLUSIONS: These recommendations provide guidance for the approach to the management of WOPN according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base regarding the treatment of WOPN.