title: Asian consensus statements on endoscopic management of walled-off necrosis Part 1: Epidemiology, diagnosis, and treatment.
abstract: Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 1 of this statement focused on the epidemiology, diagnosis, and timing of intervention.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. isayama-tky@umin.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.affiliation: Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Christopher
authors.initials: C
authors.lastname: Khor
authors.affiliation: Department of Surgery, Endoscopic Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: James
authors.initials: J
authors.lastname: Lau
authors.affiliation: Endoscopic Division, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Department of Surgery, Rajavithi Hospital, Bangkok, Thailand.
authors.forename: Thawee
authors.initials: T
authors.lastname: Ratanachu-Ek
authors.affiliation: Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Lakhtakia
authors.affiliation: Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.affiliation: Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
authors.forename: Shomei
authors.initials: S
authors.lastname: Ryozawa
authors.affiliation: Department of Gastroenterology, Hokkaido Cancer Center, Sapporo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Natusyo
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwashita
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kuwatani
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Hanada
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.affiliation: Prince Court Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ponnudurai
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soon Chun Hyang University School of Medicine, Bucheon/Seoul, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.affiliation: Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Iruru
authors.initials: I
authors.lastname: Maetani
mesh_terms: D003697:Delphi Technique; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D015994:Incidence; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed
keywords: acute necrotizing pancreatitis; endoscopic necrosectomy; endoscopy; endosonography; walled-off necrosis