title: Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review.
abstract: OBJECTIVE
  We performed a systematic review to assess the outcome of endoscopic transluminal necrosectomy in necrotising pancreatitis with additional focus on indication, disease severity, and methodological quality of studies.
  
  
  METHODS
  We searched the literature published between January 2005 and June 2013. Cohorts, including patients with (infected) necrotising pancreatitis, undergoing endoscopic necrosectomy were included. Indication, disease severity, and methodological quality were described. The main outcomes were mortality, major complications, number of endoscopic sessions, and definitive successful treatment with endoscopic necrosectomy alone.
  
  
  RESULTS
  After screening 581 papers, 14 studies, including 455 patients, fulfilled the eligibility criteria. All included studies were retrospective analyses except for one randomized, controlled trial. Overall methodological quality was moderate to low (mean 5, range 2-9). Less than 50 % of studies reported on pre-procedural severity of disease: mean APACHE-II score before intervention was 8; organ failure was present in 23 % of patients; and infected necrosis in 57 % of patients. On average, four (range 1-23) endoscopic interventions were performed per patient. With endoscopic necrosectomy alone, definitive successful treatment was achieved in 81 % of patients. Mortality was 6 % (28/460 patients) and complications occurred in 36 % of patients. Bleeding was the most common complication.
  
  
  CONCLUSIONS
  Endoscopic transluminal necrosectomy is an effective treatment for the majority of patients with necrotising pancreatitis with acceptable mortality and complication rates. It should be noted that methodological quality of the available studies is limited and that the combined patient population of endoscopically treated patients is only moderately ill.
authors.affiliation: Department of OR/Clinical Surgical Research, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, s.vanbrunschot@pancreatitis.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Brunschot
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.forename: Rogier P
authors.initials: RP
authors.lastname: Voermans
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
mesh_terms: D003646:Debridement / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D016896:Treatment Outcome