SAGES clinical practice guidelines for the management of symptomatic walled-off pancreatic necrosis.
Publication/Presentation Date
10-1-2026
Abstract
BACKGROUND: Walled-off pancreatic necrosis (WOPN) is a serious sequela following acute pancreatitis with significant associated morbidity and mortality. These guidelines provide best practice recommendations for the management of this complication.
METHODOLOGY: A systematic review was conducted, including a literature search from 1/1/2020 to 1/24/2025, addressing four key questions regarding the management of WOPN in adults. The findings were subsequently presented to a multidisciplinary panel of surgeons, gastroenterologists, and interventional radiologists, including those from both the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Americas Hepato-Pancreato-Biliary Association (AHPBA). The GRADE methodology was then used to develop evidence-based recommendations.
RESULTS: All recommendations were based on very low certainty of evidence. A conditional recommendation was made for endoscopic management versus image-guided intervention. A conditional recommendation was made for image-guided intervention versus open surgery. A conditional recommendation was made for either minimally invasive surgery or image-guided intervention. A conditional recommendation was made for minimally invasive surgery versus endoscopic intervention. A conditional recommendation was made for either a pure endoscopic approach versus a step-up approach.
CONCLUSIONS: These recommendations provide guidance for the approach to the management of WOPN according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base regarding the treatment of WOPN.
Volume
40
Issue
10
First Page
8229
Last Page
8249
ISSN
1432-2218
Published In/Presented At
Calabrese, E. C., Shehata, D., Slater, B. J., Palazzo, F., Alseidi, A., Sun, J., Onkendi, E., Molina, D. C., Mallette, K., Ricker, A. B., Ayloo, S., Lyons, J., Maddern, G., Oviedo, R. J., Elhadi, M., Kchaou, A., Shaikh, S., Maegawa, F. B., Catanzaro, A., Shlansky-Goldberg, R. D., … El-Hayek, K. (2026). SAGES clinical practice guidelines for the management of symptomatic walled-off pancreatic necrosis. Surgical endoscopy, 40(10), 8229–8249. https://doi.org/10.1007/s00464-026-13230-5
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
42675307
Department(s)
Administration and Leadership
Document Type
Article