Comparative Effectiveness of Endoscopic and Percutaneous Drainage of Walled-Off Pancreatic Necrosis

Background: Acute necrotizing pancreatitis can get complicated with walled-off pancreatic necrosis (WOPN) that require drainage. Endoscopic drainage (ED) and percutaneous drainage (PCD) are minimally invasive techniques used, each with its unique risk-benefit profile. This study aimed to assess the clinical outcomesand health care resources utilization of each drainage approach. Methods: Data from the National Inpatient Sample (NIS) for 2016 to 2022 were analyzed to identify adult hospitalizations with acute necrotizing pancreatitis as the principal diagnosis. Patients who underwent a single drainage modality, as determined by ICD-10 codes, were included. A one-to-one propensity score matching was performed to balance the ED and PCD groups. Outcomes measured included hospital length of stay, total hospitalization cost, mortality, intensive care unit admissions (ICU), and blood loss. Results: After matching, 1370 patients were analyzed in each group. The ED group exhibited a significantly shorter length of stay compared with the PCD group (16.8 vs. 20.7 d, P =0.03). Patients undergoing ED had significantly lower rates of blood transfusion (9.12% vs. 18.25%, aOR: 0.45; 95% CI: 0.27-0.75, P =0.002), mechanical ventilation (6.93% vs. 16.06%, aOR: 0.39; 95% CI: 0.22-0.68, P =0.008), and septic shock (5.11% vs. 9.12%, aOR: 0.54; 95% CI: 0.27-0.75, P =0.006). In addition, ED showed a nonsignificant trend toward lower in-hospital mortality versus PCD (2.19% vs. 5.11%; aOR 0.42, 95% CI 0.16-1.10; P =0.07). Although the total cost of hospitalization was significantly lower for the ED group ($194,688 vs. $239,860), this difference was not statistically significant ( P =0.11). Conclusions: Endoscopic drainage (ED) is associated with shorter hospital stay, lower rates of intensive care unit admissions, and complications, including blood loss, mechanical ventilation, and septic shock, compared with percutaneous drainage in patients with walled-off pancreatic necrosis, with nonsignificant trend toward lower mortality with ED. When feasible and expertise is available, the endoscopic approach should be used as the primary modality for walled-off pancreatic necrosis.