Walled-off pancreatic necrosis (WOPN) is a complication of acute pancreatitis that often requires endoscopic intervention for drainage and necrosectomy. The choice of stent type for endoscopic drainage remains debated, with double-pigtail plastic stents and lumen-apposing metal stents (LAMS) being the most commonly used options.

The aim of our study was to evaluate the efficacy and safety of endoscopic drainage in the management of walled-off pancreatic necrosis (WOPN) in our center

 We conducted a single-center retrospective descriptive study in our gastroenterology, and interventional endoscopy department, including patients admitted for endoscopic drainage of symptomatic WOPN between 2019 and 2025. Epidemiological, clinical, endoscopic, and outcome data were analyzed

 Among the 63 patients followed for acute necrotizing pancreatitis, eleven developed a symptomatic WOPN, an incidence of 17,4%. The mean age was 59 years (range :38-73). The sex ratio was 2,7 (M/F = 8/3). WOPN was a complication of biliary acute necrotizing pancreatitis of in 81.8% of cases (N=9), alcoholic in 9.1% of cases (N=1) and metabolic in 9.1% of cases (N=1).

All patients were symptomatic. Abdominal pain was the most common symptom in all patients (N=11), followed by vomiting (N=7). Two patients reported significant weight loss. Eight patients had a complicated form: compression of a neighboring organ (N=5), or infected WOPN (N=3). The compression was either vascular (N=4) causing segmental portal hypertension, or biliary (N=1) with overt jaundice. The WOPN was single in 72.7 % of cases (N=8). The location was in the pancreatic body, allowing access through the posterior gastric wall. The average size was 9,4 cm (range:4,7-20cm). During esophagogastroduodenoscopy or duodenoscopy, gastric stasis was noted in 2 patients, gastric mucosal bulging in 4 patients, and congestive gastric or bulbar mucosa in all patients. One patient had bulbar stenosis. Under endoscopic ultrasound (EUS), the WOPN had heterogeneous content with at least 30% necrotic material in 45.5% of cases (N=5), and more than 60% in 18% of cases (N=2) .

All patients underwent drainage under endoscopic ultrasound guidance. The route was transgastric in all cases. A cystotome was used to create the gastro-cystic fistula in all patients, followed by hydrostatic dilation in 4 patients.

Two double-pigtail plastic stents (7 Fr) were placed in seven patients, abiflanged metal stent in three patients. and a HOT AXIOS covered metal stent kit in one patient. Drainage was successful in all patients, with purulent fluid discharge in 5 patients and partial collapse of the WON under endoscopic ultrasound control. Regarding outcomes, one patient had persistent pain requiring two subsequent endoscopic necrosectomy sessions, three patients had disconnected pancreatic duct syndrome, requiring prolonged placement of plastic stents. The remaining patients had favorable outcomes with stent removal.

Endoscopic drainage of walled-off pancreatic necrosis (WOPN) is a safe and effective option, with a success rate of 100% in our series. The use of endoscopy ultrasound improves procedural safety and patient selection. careful monitoring for complications remains essential to optimize outcomes.