Background and Aim: The incidence of acute pancreatitis is rising around the world, thus further increasing the burden on healthcare services. Approximately 10% of patients with acute pancreatitis will develop infected necrotizing pancreatitis, which is the leading cause of high mortality in the late phase. There is currently no consensus with regard to the use of endoscopic or minimally invasive surgical as the first-line therapy of choice for infected necrotizing pancreatitis. However, more clinical research regarding the superiority of the endoscopic approach has been published recently. Therefore, we conducted a systematic review and meta-analysis to determine which of the two treatments leads to a better prognosis.

Methods: Four databases (Medline, SinoMed, EMBASE, and Cochrane Library) were searched for eligible studies from 1980 to 2018 comparing endoscopic and minimally invasive surgical for infected necrotizing pancreatitis.

Results: Two RCTs and seven clinical cohort studies were included. After the analysis of data amenable to polling, significant advantages were found in favor of the endoscopic approach in terms of pancreatic fistula (OR=0.10, 95%CI 0.04–0.30, P<0.001)and length of hospital stay (WMD=–24.72, 95%CI=–33.87 to –15.57, P<0.001). No marked differences were found in terms of mortality, multiple organ failure, intra-abdominal bleeding, enterocutaneous fistula, recurrence of pseudocysts, length of stay in the ICU, endocrine insufficiency and exocrine insufficiency.

Conclusion: Compared with minimally invasive surgical, endoscopic remedy evidently improved short-term outcomes for infected necrotizing pancreatitis, including pancreatic fistula and length of hospital stay. Furthermore, relevant multicenter RCTs are eager to prove these findings.