Endoscopic management of pancreatic walled-off necrosis

Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis.Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections.Endoscopy offers a minimally invasive approach when compared to surgical drainage.Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections.Current data suggest that all 3 approaches yield similar outcomes.It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature.However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable.Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.