CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(03): E258-E267
DOI: 10.1055/a-1935-4738
Original article

Percutaneous endoscopic necrosectomy (PEN) for treatment of necrotizing pancreatitis: a systematic review and meta-analysis

Mihajlo Gjeorgjievski
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Abishek Bhurwal
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Abhishek A. Chouthai
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Abdelhai Abdelqader
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Monica Gaidhane
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Haroon Shahid
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Amy Tyberg
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Avik Sarkar
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Michel Kahaleh
1   Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
› Author Affiliations


Background and study aims Endoscopic necrosectomy is limited by the proximity of necrosis to the gastrointestinal tract. Percutaneous endoscopic necrosectomy (PEN) is a minimally invasive endoscopic method of percutaneous debridement. Studies regarding its efficacy and safety are lacking. The purpose of this study was to assess the efficacy and safety of PEN in necrotizing pancreatitis.

Methods Pubmed, Ovid, Cochrane, Scopus and Web of Science Database were searched from inception through February 2021. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. The primary outcome was defined as clinical success of PEN. Secondary outcomes included periprocedural morbidity, mortality, and long-term morbidity and mortality.

Results Sixteen observational studies including 282 subjects were analyzed. The average reported age of the participants was 50.3 years. Patients with reported gender included 39 % females and 61 % males. The success rate as defined by complete resolution of necrosis and removal of drainage catheters/stents was 82 % (95 % confidence interval 77–87). The mean size of pancreatic necrosis was 14.86 cm (5–54 cm). The periprocedural morbidity rate was 10 %, while there was no reported periprocedural mortality. The long-term morbidity rate was reported as 23 % and mortality at follow-up was 16 %.

Conclusions PEN is a novel method of endoscopic management of pancreatic necrosis. Based on our meta-analysis of retrospective studies, it represents a safe treatment modality with high rates of clinical success and low rates of perioperative morbidity and mortality. This study supports the use of PEN when conventional endoscopic therapy is not feasible.

Supplementary material

Publication History

Received: 27 October 2021

Accepted after revision: 10 August 2022

Article published online:
23 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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