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Background and Aims: Necrotizing pancreatitis is a severe complication seen in 15-20% of patients who present with acute interstitial pancreatitis and is associated with significant morbidity and mortality. The management of necrotic collections in patients with necrotizing pancreatitis has been revolutionized by minimally invasive techniques, such as endoscopic ultrasound (EUS)-guided drainage. The timing of endoscopic intervention for these collections remains contentious. The primary aim of this audit was to compare the outcomes and characteristics of patients who required early endoscopic drainage (<4 weeks) versus those who needed late drainage (>4 weeks) of these collections and to assess whether necrosectomy is commonly required in this cohort. Method(s): We performed a retrospective analysis of prospectively collected data from 2012 to 2021 of consecutive patients in a single tertiary center who had EUS-guided cystogastrostomy for symptomatic pancreatic necrotic collections. Necrosis had been confirmed by a specialist radiologist on computed tomography scan. The decision regarding the timing for endoscopic intervention (early vs late) for these patients was based on clinical assessment, review of imaging, pathology test results, and a multidisciplinary discussion with radiologists, surgeons, and gastroenterologists. Patients were excluded if follow-up data were missing. The included patients' medical records, pathology results, imaging findings, and procedural reports were retrospectively reviewed. Cystogastrostomies were performed for patients if the pancreatic necrotic collections were causing sepsis or outlet obstruction. All endoscopic drainage procedures were performed by trained interventional endoscopists (either one of two gastroenterologists or a hepatobiliary surgeon) in a single tertiary center. Two different types of stents were used for endoscopic drainage: plastic double pigtail stents and lumen-apposing metal stents (LAMS), or both, without fl

Background and Aims: Necrotizing pancreatitis is a severe complication seen in 15-20% of patients who present with acute interstitial pancreatitis and is associated with significant morbidity and mortality. The management of necrotic collections in patients with necrotizing pancreatitis has been revolutionized by minimally invasive techniques, such as endoscopic ultrasound (EUS)-guided drainage. The timing of endoscopic intervention for these collections remains contentious. The primary aim of this audit was to compare the outcomes and characteristics of patients who required early endoscopic drainage (<4 weeks) versus those who needed late drainage (>4 weeks) of these collections and to assess whether necrosectomy is commonly required in this cohort. Method(s): We performed a retrospective analysis of prospectively collected data from 2012 to 2021 of consecutive patients in a single tertiary center who had EUS-guided cystogastrostomy for symptomatic pancreatic necrotic collections. Necrosis had been confirmed by a specialist radiologist on computed tomography scan. The decision regarding the timing for endoscopic intervention (early vs late) for these patients was based on clinical assessment, review of imaging, pathology test results, and a multidisciplinary discussion with radiologists, surgeons, and gastroenterologists. Patients were excluded if follow-up data were missing. The included patients' medical records, pathology results, imaging findings, and procedural reports were retrospectively reviewed. Cystogastrostomies were performed for patients if the pancreatic necrotic collections were causing sepsis or outlet obstruction. All endoscopic drainage procedures were performed by trained interventional endoscopists (either one of two gastroenterologists or a hepatobiliary surgeon) in a single tertiary center. Two different types of stents were used for endoscopic drainage: plastic double pigtail stents and lumen-apposing metal stents (LAMS), or both, without fl