SAGES clinical practice guidelines for the management of symptomatic walled-off pancreatic necrosis
In brief
Guidelines favor endoscopic over surgical approaches for walled-off pancreatic necrosis
The new SAGES/AHPBA guidelines issue conditional recommendations that endoscopic drainage is preferred to image-guided or open surgery for symptomatic walled-off pancreatic necrosis, but all advice rests on very low-certainty evidence. Experts also note that minimally invasive surgery and step-up strategies are reasonable alternatives, underscoring major gaps that need stronger research.
- Journal
- Surgical endoscopy (Q1)
- Published
- 31 August 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Elisa C Calabrese, Dena Shehata, Bethany J Slater, Francesco Palazzo, Adnan Alseidi, James Sun, et al.
- PMID
- 42675307
- DOI
- 10.1007/s00464-026-13230-5
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 6 September 2026): Guidelines for managing symptomatic walled‑off pancreatic necrosis
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.