Direct Endoscopic Necrosectomy With and Without Hydrogen Peroxide for Walled-off Pancreatic Necrosis: A Multicenter Comparative Study

Ahmed A. Messallam, Douglas G. Adler, Raj J. Shah, Jose M. Nieto, Robert Moran, B. Joseph Elmunzer, Natalie Cosgrove, Dan Mullady, Harkirat Singh, Gregory Cote, Georgios I. Papachristou, Mohamed O. Othman, Chao Zhang, Huma Javaid, Michael Mercado, Steven Tsistrakis, Nikhil A. Kumta, Satish Nagula, Christopher J. Dimaio, Madeleine S. BirchLinda Jo Taylor, Nicolas Labarre, Samuel Han, Thomas Hollander, Steven A. Keilin, Qiang Cai, Field F. Willingham

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


INTRODUCTION:Endoscopic necrosectomy has emerged as the preferred treatment modality for walled-off pancreatic necrosis. This study was designed to evaluate the safety and efficacy of direct endoscopic necrosectomy with and without hydrogen peroxide (H2O2) lavage.METHODS:Retrospective chart reviews were performed for all patients undergoing endoscopic transmural management of walled-off pancreatic necrosis at 9 major medical centers from November 2011 to August 2018. Clinical success was defined as the resolution of the collection by imaging within 6 months, without requiring non-endoscopic procedures or surgery.RESULTS:Of 293 patients, 204 met the inclusion criteria. Technical and clinical success rates were 100% (204/204) and 81% (166/189), respectively. For patients, 122 (59.8%) patients had at least one H2O2necrosectomy (H2O2group) and 82 (40.2%) patients had standard endoscopic necrosectomy. Clinical success was higher in the H2O2group: 106/113 (93.8%) vs 60/76 (78.9%), P = 0.002. On a multivariate analysis, the use of H2O2was associated with higher clinical success rate (odds ratio 3.30, P = 0.033) and earlier resolution (odds ratio 2.27, P < 0.001). During a mean follow-up of 274 days, 27 complications occurred. Comparing procedures performed with and without H2O2(n = 250 vs 183), there was no difference in post-procedure bleeding (7 vs 9, P = 0.25), perforation (2 vs 3, P = 0.66), infection (1 vs 2, P = 0.58), or overall complication rate (n = 13 [5.2%] vs 14 [7.7%], P = 0.30).DISCUSSION:H2O2-assisted endoscopic necrosectomy had a higher clinical success rate and a shorter time to resolution with equivalent complication rates relative to standard necrosectomy.See the visual abstract at

Original languageEnglish
Pages (from-to)700-709
Number of pages10
JournalAmerican Journal of Gastroenterology
Issue number4
StatePublished - Apr 1 2021


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