S228 Comparison of Outcomes in Open Surgical Necrostomy and Endoscopic Necrostomy for Infected Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis

Introduction: While open surgical necrosectomy was once the standard for infected necrotizing pancreatitis (INP) it carries high morbidity and prolonged recovery. In recent years, minimally invasive endoscopic approaches have gained traction as safer alternatives, offering targeted drainage and debridement with reduced physiological stress. Emerging evidence suggests endoscopic treatment may lead to better clinical outcomes, including fewer complications and shorter hospital stays. This meta-analysis compares the efficacy and safety of endoscopic vs surgical interventions for managing INP. Methods: The review conducted follows the PRISMA guidelines. PUBMED, Google Scholar and Science-Direct, were searched using a comprehensive search term to identify and retrieve available articles. The articles included the assessment of outcomes following endoscopic and surgical management of INP. The data was analyzed using the Meta, Metadata and the Metafor packages of R Studio. The odds ratio of mortality between the 2 groups following endoscopy and surgical management for INP was considered the primary outcome. Mean difference in hospital stay, risk of multiple adverse events including the occurrence of pancreatic fistula, perforation, multiorgan failure and odds ratio of treatment success were considered as secondary outcomes. The Mantel-Haenszel method and the Inverse variance method were utilized to analyze the odds ratio and risk ratio. Results: The study includes a total of 10 papers, which include a total of 346 subjects undergoing endoscopic treatment and 363 subjects undergoing surgical treatment. The risk of mortality was statistically insignificant in both groups, indicating similar therapeutic efficacy. (odds ratio = 0.91 (0.59; 1.41), P = 0.28). The risk of developing pancreatic fistula (0.74), and perforation (0.62) was similar in both groups. The mean difference of hospital stay following the endoscopic procedure was significantly lower than the surgery procedure, indicating a quicker recovery (MDS = - 5,16 (-12.62; 2.29), P = 0.0097). The risk of multiple organ failure was significantly lower in the endoscopic group (0.41 (0.24; 0.72)). Conclusion: The study indicates similar clinical outcomes following endoscopic pancreatic necrostomy and surgical necrostomy for the management of Infected necrotising pancreatitis. Endoscopic therapies perform better in terms of adverse events and recovery time in comparison to surgical therapies.