BACKGROUND AND AIMS Pancreatic necrosis may be categorized as an acute necrotic collection (ANC) or walled-off necrosis (WON) based on complete encapsulation by a wall and collection age (≤4 weeks or >4 weeks). Endoscopic intervention of WON has become the standard of care, but little is known regarding the safety and efficacy of endoscopic intervention of pancreatic necrosis ≤4 weeks from disease onset. METHODS Retrospective review of medical records and imaging studies of all patients undergoing early endoscopic intervention of pancreatic necrosis between 2008 and 2018 was carried out at 1 referral center. Patients who underwent previous interventional treatment were excluded. Control WON patients were matched to early intervention cases. The primary outcome was defined as resolution of the collection after endoscopic treatment, without surgery. RESULTS Nineteen patients with early intervention were identified. The most common indication for intervention was infection. Median age of these collections at the time of initial endoscopic intervention was 23 days (range, 15-27 days), and all collections had a partial or complete wall discernable on contrast-enhanced CT. Eleven patients underwent concurrent endoscopic necrosectomy. The primary outcome was achieved in all patients in the early intervention group. Total duration of therapy was longer for early intervention compared with controls (103 vs 69 days, P = .042), with no mortality and similar adverse event rates compared with controls. CONCLUSIONS Endoscopic intervention of pancreatic necrosis in the third and fourth weeks of illness appears effective and safe when a partial collection wall is present on cross-sectional imaging studies, with outcomes paralleling those reported for intervention of WON.

中文翻译：

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胰腺内坏死收集的早期内镜干预结果：匹配的病例对照研究。

背景和目的胰腺坏死可根据完全包封的壁和收集年龄（≤4周或> 4周）分类为急性坏死性集合（ANC）或壁状坏死（WON）。WON的内镜干预已成为护理的标准，但对于发病后≤4周的胰腺坏死的内镜干预的安全性和有效性知之甚少。方法在1个转诊中心对所有在2008年至2018年间接受胰腺内坏死早期内镜干预的患者的病历和影像学研究进行回顾性回顾。排除接受过先前介入治疗的患者。对照WON患者与早期干预病例相匹配。主要结果定义为内窥镜治疗后采集物的分辨率，无需手术。结果确定了19例早期干预患者。干预的最常见指征是感染。初次内窥镜干预时这些收集物的中位年龄为23天（范围为15-27天），并且所有收集物在对比增强CT上均可辨认出部分或完整的壁。11例患者同时行内镜坏死切除术。早期干预组中的所有患者均达到了主要结局。与对照组相比，早期干预的总治疗时间更长（103天vs 69天，P = .042），与对照组相比无死亡率和相似的不良事件发生率。