In recent decades, constant development of minimally invasive techniques for the treatment of the consequences of acute necrotizing pancreatitis can be observed. The choice of access to the necrotic collection should mainly depend on the location of necrotic changes and experience of the medical center. Endoscopic transmural drainage of extensive necrotic collections may require the use of an additional route of access to the necrosis. In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis.

513 consecutive patients with symptomatic walled-off pancreatic and peripancreatic necrosis treated in the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń, Poland between 2018 and 2025 were included. The analyzed patients were treated withusing the novel method of endoscopic percutaneous necrosectomy, in which percutaneous access to the necrotic collection was achieved with use ofby retroperitoneal route; consequently, the access was then widened, and a self-expanding metal stent was placed percutaneously,, which allowed to introduce the endoscope percutaneously into the necrotic area and to perform endoscopic necrosectomy.

In 39/513 (7.60%) patients with symptomatic walled-off pancreatic and peripancreatic necrosis an,  additional percutaneous drainage was performed during the endotherapy.  Within this group, In 9/39 (23.07%) patients (2 females and 7 males; average age 46.72 [31-–65] years) were qualified to percutaneous endoscopic necrosectomy. The aAverage size of the necrotic collection was 25.96 (15.24-–32.5) cm. AAn active percutaneous drainage during transmural endoscopic drainage lastedwas continued  for 15 (11-31) days. The aAverage number of procedures of percutaneous endoscopic necrosectomy procedures was 3.12 (1-–7). Complications of treatment were stated observed in 2/9 (22%) patients. Clinical success was achieved acknowledged in 8/9 (88.8%) patients. Long-term success was stated achieved in 8/9 (88.8%) patients. 

Percutaneous endoscopic necrosectomy during in the course of transmural endoscopic drainage of walled-off pancreatic and peripancreatic necrosis is an effective method of minimally invasive treatment, especially in cases of spreading necrotic changes spreading within the pelvic area.