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Endoscopy
DOI: 10.1055/a-2654-4317
Original article

Encapsulation levels rather than elapsed time after the onset of acute pancreatitis are related to clinical outcomes of pancreatic walled-off necrosis

Authors

  • Akinori Maruta  ‡

    1   Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan (Ringgold ID: RIN68266)

  • Takuji Iwashita  ‡

    2   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)

  • Tomotaka Saito 

    3   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)

  • Wataru Gonoi

    4   Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)

  • Kensaku Yoshida

    1   Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan (Ringgold ID: RIN68266)

  • Shunsuke Omoto 

    5   Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan (Ringgold ID: RIN326473)

  • Mamoru Takenaka 

    5   Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan (Ringgold ID: RIN326473)

  • Masahiro Tsujimae

    6   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan (Ringgold ID: RIN38303)

  • Atsuhiro Masuda

    6   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan (Ringgold ID: RIN38303)

  • Tsuyoshi Hamada

    3   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)
    7   Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan (Ringgold ID: RIN13609)

  • Shinya Uemura

    2   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)

  • Shogo Ota 

    8   Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan (Ringgold ID: RIN26289)

  • Hideyuki Shiomi

    8   Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan (Ringgold ID: RIN26289)

  • Kentaro Suda

    9   Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan (Ringgold ID: RIN26381)

  • Saburo Matsubara 

    9   Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan (Ringgold ID: RIN26381)

  • Sho Takahashi

    10   Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan (Ringgold ID: RIN73362)

  • Toshio Fujisawa 

    10   Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan (Ringgold ID: RIN73362)

  • Yuhei Iwasa

    11   Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan (Ringgold ID: RIN38226)

  • Keisuke Iwata

    11   Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan (Ringgold ID: RIN38226)

  • Nobuhiko Hayashi

    12   Third Department of Internal Medicine, University of Toyama, Toyama, Japan (Ringgold ID: RIN34823)

  • Tsuyoshi Mukai

    13   Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan (Ringgold ID: RIN12857)

  • Hiroyuki Isayama 

    10   Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan (Ringgold ID: RIN73362)

  • Ichiro Yasuda

    12   Third Department of Internal Medicine, University of Toyama, Toyama, Japan (Ringgold ID: RIN34823)

  • Yousuke Nakai

    3   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)
    14   Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan (Ringgold ID: RIN13131)
    • on behalf of the WONDERFUL study group

Supported by: Japanese Foundation for Research and Promotion of Endoscopy B/#1015
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Graphical Abstract

Abstract

Background

There is no consensus regarding the optimal timing of endoscopic ultrasound (EUS)-guided interventions for walled-off necrosis (WON) secondary to acute pancreatitis. Currently, intervention timing is primarily determined by the duration after the onset of acute pancreatitis, which potentially serves as a surrogate for fluid collection maturation. We hypothesized that the encapsulation status may be more strongly correlated with clinical outcomes.

Methods

Between January 2010 and November 2020, 222 patients who underwent EUS-guided WON treatment at 11 centers of the WONDERFUL consortium were included. The patients were divided into two groups based on their encapsulation status at drainage (partial/no vs. complete). The clinical outcomes were compared between groups.

Results

Technical success rates were similar between the groups. Complete encapsulation was associated with a higher clinical success rate (88.1% vs. 52.2%; P<0.001). When patients were classified by both time elapsed and encapsulation status, the encapsulation status was more strongly associated with clinical success. Complete encapsulation was associated with a lower overall adverse event rate (22.7% vs. 39.1%; P=0.04). Overall mortality was significantly higher in the partial/no encapsulation group (34.8% vs. 3.4%; P <0.001). In multivariable analysis, the encapsulation status and diameter of the WON were identified as significant factors associated with clinical success.

Conclusions

In patients undergoing EUS-guided WON treatment, the encapsulation status, rather than the time elapsed since disease onset, appeared to be more strongly associated with positive clinical outcomes.

Supplementary Material



Publication History

Received: 23 December 2024

Accepted after revision: 11 July 2025

Accepted Manuscript online:
12 July 2025

Article published online:
03 September 2025

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