Lariño Noia, JoséIglesia García, Daniel de laGonzález López, JavierDíaz López, J.Macías García, FernandoMejuto, RafaelQuiroga, AdrianoMauriz, VioletaJardí, AndreaIglesias García, JulioDomínguez Muñoz, Juan Enrique2025-01-212025-01-212020-02-19Lariño-Noia, J., de la Iglesia-García, D., González-Lopez, J. et al. Endoscopic drainage with local infusion of antibiotics to avoid necrosectomy of infected walled-off necrosis. Surg Endosc 35, 644–651 (2021). https://doi.org/10.1007/s00464-020-07428-40930-2794https://hdl.handle.net/10347/38833Background : Current treatment of infected pancreatic necrosis (IPN) follows a step-up approach. Our group designed a step-up protocol that associates endoscopic drainage with local infusion of antibiotics through transmural nasocystic catheter. Aim of our study was to evaluate our step-up protocol for IPN in terms of proportion of patients avoiding necrosectomy. Methods : Retrospective analysis of patients admitted with acute pancreatitis (AP) between January 2015 and December 2018. The number of patients who responded to each therapeutic step were analysed: step 1, systemic antibiotics; step 2, endoscopic transmural drainage and local infusion of antibiotics; step 3, endoscopic necrosectomy. Results : 1158 patients with AP were included. 110 patients (8.4%) suffered from necrotising pancreatitis; 48 of them had IPN (42.6% of necrotising pancreatitis) and were treated with systemic antibiotics. Nineteen patients (39.6% of IPN) responded and did not required any invasive therapy. Six patients with IPN on systemic antibiotics died within the first 4 weeks of disease before step 2 could be applied. Urgent surgical necrosectomy in the first 4 weeks was performed in three additional patients. Endoscopic drainage and local antibiotic therapy was performed in the remaining 20 patients; 9 (45% of them) did well and 9 patients underwent necrosectomy (18.7% of IPN). Two patients died on drainage. Overall mortality of the total cohort of AP was 2.53%. Conclusions : Addition of local infusion of antibiotics to endoscopic drainage avoids the need of necrosectomy in half of patients with IPN not responding to systemic antibiotics.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/PancreatitisEndosonographyCarbapenemAntibiotic resistanceEndoscopic necrosectomy24 Ciencias de la vidajournal article10.1007/s00464-020-07428-41432-2218open access