Download PDF
Endoscopy 2026; 58(03): 317-318
DOI: 10.1055/a-2764-1669
Letter to the editor

Reply to Vanella et al.

Authors

  • Akinori Maruta 

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

  • Takuji Iwashita 

    2   Gastroenterology, Shiga University of Medical Science Hospital, Otsu, Japan (Ringgold ID: RIN469340)

  • Tomotaka Saito 

    3   Gastroenterology, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)

  • Wataru Gonoi

    4   Radiology, The University of Tokyo, Tokyo, Japan (Ringgold ID: RIN13143)

  • Tsuyoshi Hamada

    5   Gastroenterology, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo, Japan (Ringgold ID: RIN38551)

  • Hiroyuki Isayama 

    6   Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan (Ringgold ID: RIN73362)

  • Ichiro Yasuda

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

  • Yousuke Nakai

    8   Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan (Ringgold ID: RIN13131)
Further Information
Also available at
   Permissions and Reprints

10.1055/a-2749-8235

We wish to thank Vanella et al. for their valuable comments on our research. Although our study suggests that the clinical outcomes of walled-off necrosis (WON) were more strongly associated with the degree of encapsulation than with the time elapsed since the onset of pancreatitis, there are some limitations owing to its retrospective nature.

The definition of encapsulation has not been well standardized, and we defined the maturation of a WON wall as the presence of a discrete enhanced margin of ≥1 mm of the WON, with complete and partial/no encapsulation being defined by the maturation of ≥80% and <80% of the wall, respectively. Computed tomography (CT) images were retrospectively reviewed by both a radiologist and a gastroenterologist, and we had a relatively high concordance rate of 88%; however, we did encounter discrepancies in the image interpretation in cases with uneven encapsulation. The interpretation by gastroenterologists may be less accurate than that by radiologists, who have good access to working stations for CT images. A standardized definition of encapsulation needs to be established to further investigate its role in the management of WON. In addition, artificial intelligence-based diagnostic platforms could help with the accurate and objective interpretations of gastroenterologists, who mainly manage WON in clinical practice. As Baroud and colleagues advocated, other clinical parameters, including the Quadrant-Necrosis-Infection (QNI) criteria [1], should be investigated in combination with encapsulation levels for a better prediction of clinical outcomes.

Because this was a hypothesis-generating study, our WONDERDUL group is currently conducting a randomized controlled trial comparing timing-oriented and encapsulation-oriented endoscopic ultrasound-guided drainage for WON (ClinicalTrials.gov NCT07106346), and we hope the study results will further demonstrate the importance of encapsulation in the management of WON.



Publication History

Article published online:
20 February 2026

© 2026. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany