Paradigm shift away from open surgical necrosectomy toward endoscopic interventions for necrotizing pancreatitis

Interventions for infected and symptomatic walled-off pancreatic necrosis (WOPN) have undergone a paradigm shift away from open surgical necrosectomy toward endoscopic intervention such as transmural drainage and necrosectomy. Recent multicenter studies and evidence-based guidelines have suggested the safety and efficacy of endoscopic transmural necrosectomy (ETN) for management of complicated WOPN. In consideration of the inherent properties and the risks associated with this procedure, ETN should be performed by expert endoscopists who are well-versed in management of necrotizing pancreatitis and supported by a special multidisciplinary team. Although there have been limited data to define the selection criteria and the techniques regarding ETN, this comprehensive review focuses on the current indications, therapeutic outcomes, complications, and controversies of ETN for management of WOPN.