4 Efficacy
This section describes efficacy outcomes from the published literature that the committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview.
4.1
In a systematic review of 938 patients, the mean clinical success rate of endoscopic necrosectomy was 89% (range 50 to 100%). In a non-randomised comparative study (included in the systematic review), 24 patients were treated by endoscopic necrosectomy or a step-up approach (percutaneous catheter drainage with possible surgery). Clinical resolution (defined as resolution of primary symptoms and no abdominal pain, nausea, vomiting, fever, leucocytosis or sepsis) was reported in 92% (11/12) of patients after endoscopic necrosectomy and 25% (3/12) of patients after percutaneous catheter drainage in the step-up approach group (p=0.0028).
4.2
In a systematic review of 455 patients, 16% (73/455) of patients needed additional interventions after endoscopic necrosectomy (18 percutaneous, 46 surgical, 7 percutaneous and surgical, 2 other). In a case series of 81 patients (included in the systematic review of 938 patients), small collections of necrotic tissue and fluid that caused symptoms recurred in 4% (3/72) of patients. These patients needed additional endoscopic treatment, which resulted in complete resolution. In a case series of 57 patients (included in the systematic review of 938 patients), 5% (3/57) of patients had a recurrent cavity after 2 to 8 months; they were successfully treated by endoscopic or percutaneous drainage.
4.3
In a randomised controlled trial of 20 patients treated by endoscopic or surgical necrosectomy (included in the systematic reviews), hospital stays after randomisation were 45 and 36 days respectively (p=0.91). In a non-randomised comparative study of 32 patients treated by endoscopic or surgical necrosectomy (included in the systematic review of 938 patients), median length of hospital stay was 32 and 74 days respectively (p=0.006).
4.4
The specialist advisers listed the key efficacy outcomes as resolution of the necrotic cavity, reduced length of stay in a high dependency or intensive care unit, and quality of life.