Step-up Approach for Walled-off Necrosis: Outcomes and Risk Factor Analysis for Endoscopic Treatment Failure

Abstract

We conducted a retrospective analysis of 87 patients with walled-off necrosis (WON) treated using a step-up approach at ABC Hospital between 2005 and 2019. The overall clinical success rate was 86.2%. However, logistic regression analysis revealed that a high Charlson Comorbidity Index (CCI) and extension of WON into the pelvic cavity were significant independent risk factors for endoscopic treatment failure and percutaneous drainage failure. Additionally, a high CCI was identified as a significant independent risk factor for mortality. Successful step-up approach for WON requires multidisciplinary teamwork, and patients with multiple comorbidities have a high mortality risk. Therefore, support from regional partnerships to enable transfer of patients to appropriate medical facilities as necessary is crucial.