Radiologic Predictors of Increased Number of Necrosectomies During Endoscopic Management of Walled-off Pancreatic Necrosis

Natalie Cosgrove, Anup Shetty, Richard McLean, Swaroop Vitta, Mir F. Faisal, Sultan Mahmood, Dayna Early, Dan Mullady, Koushik Das, Gabriel Lang, Theresa Thai, Taseen Syed, John Maple, Sreeni Jonnalagadda, Kelli Andresen, Thomas Hollander, Vladimir Kushnir

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Goals: No established methods exist to predict who will require a higher number of endoscopic necrosectomy sessions for walled-off necrosis (WON). We aim to identify radiologic predictors for requiring a greater number of necrosectomy sessions. This may help to identify patients who benefit from aggressive endoscopic management. Materials and Methods: This is a multicenter retrospective study of patients with WON at 3 tertiary care centers. WON characteristics on preintervention computed tomography imaging were evaluated to determine if they were predictive of requiring more endoscopic necrosectomy. Results: A total of 104 patients were included. Seventy patients (67.3%) underwent endoscopic necrosectomy, with median of 2 necrosectomies. WON largest transverse diameters (P=0.02), largest coronal diameters (P=0.01), necrosis pattern [likelihood ratio (LR)=17.85, P<0.001], spread (LR=11.02, P=0.01), hemorrhage (LR=8.64, P=0.003), and presence of disconnected pancreatic duct (LR=6.80, P=0.01) were associated with undergoing ≥2 necrosectomies. Patients with septations/loculations were significantly less likely to undergo ≥2 necrosectomies (LR=4.86, P=0.03). Conclusions: Several computed tomography radiologic features were significantly associated with undergoing ≥2 necrosectomies. These could help identify patients who will undergo a higher number of endoscopic necrosectomy sessions.

Original languageEnglish
Pages (from-to)457-463
Number of pages7
JournalJournal of Clinical Gastroenterology
Issue number5
StatePublished - May 1 2022


  • endoscopic necrosectomy
  • pancreatic fluid collections
  • radiologic predictors
  • walled-off pancreatic necrosis


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