To compare the efficacy and safety of endoscopic ultrasound-guided (EUS-guided) drainage with metal stent and percutaneous nephroscopic necrosectomy in the treatment of walled off necrosis (WON), and to discuss the best treatment mode of WON at different sites.

The clinical datas of patients with WON who underwent EUS-guided drainage with metal stent or percutaneous nephroscopic necrosectomy in our hospital from Oct. 2018 to Dec. 2020 were retrospectively analyzed, and the treatment success rate, procedure duration, complications, hospital stay and cost et al between the two groups were compared.

Thirteen of 38 patients included in the EUS group, and WON were confined to the pancreas or peripancreatic area. Of the 25 patients in the percutaneous nephroscopy group, 14 patients had localized to pancreas or peripancreatic area. There was no statistical difference in treatment success rate and complication rate between the two groups. And there was no statistical difference in treatment success rate and complication rate between the two groups for the WON confined to pancreas or peripancreatic area. However, the median duration of procedure, median hospital stay and median cost in the EUS group was less than that in the percutaneous nephroscopy group [(37.0 min(22.0-49.5 min) vs 90.0 min(52.5-135.0 min), P<0.00; 8 d(6-12.5 d) vs 19 d(9-40 d), P=0.002; 40 550 CNY[36 734-67 640 CNY) vs 94 151 CNY(69 813-251 510 CNY), P< 0.001].

EUS-guided drainage with metal stent is suitable for patients with WON confined to pancreas or peripancreatic area and close to gastric wall. Percutaneous nephroscopic necrosectomy is more suitable for WON involving abdominal cavity and pelvic cavity and far from the gastric wall. If the patient has different sites of cysts at the same time, EUS-guided drainage combined with percutaneous nephroscopic necrosectomy can be considered.