Original Article

Natural Course of Asymptomatic Walled-off Necrosis due to Acute Pancreatitis

Volume 37 · Issue 4 Publish Date: January 15, 2026
Melike Bektaş ORCID Şencan Acar ORCID Ahmet Tarık Eminler ORCID Mukaddes Tozlu ORCID Bilal Toka Fuldem Mutlu ORCID Mustafa İhsan Uslan ORCID Erkan Parlak ORCID Aydın Şeref Köksal ORCID
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Turkish Journal of Gastroenterology

Volume 37 · Issue 4

Pages: 420-429

History

Published Online: January 15, 2026

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2026 Melike Bektaş, Şencan Acar, Ahmet Tarık Eminler, Mukaddes Tozlu, Bilal Toka, Fuldem Mutlu, Mustafa İhsan Uslan, Erkan Parlak, Aydın Şeref Köksal

Melike Bektaş ORCID
Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Şencan Acar ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Ahmet Tarık Eminler ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Mukaddes Tozlu ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Bilal Toka
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Fuldem Mutlu ORCID
Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Mustafa İhsan Uslan ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Erkan Parlak ORCID
Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
Aydın Şeref Köksal ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Bektaş, M., Acar, Şencan, Eminler, A. T., Tozlu, M., Toka, B., Mutlu, F., … Köksal, A. Şeref. (2026). Natural Course of Asymptomatic Walled-off Necrosis due to Acute Pancreatitis. Turkish Journal of Gastroenterology, 37(4), 420–429. https://doi.org/10.5152/tjg.2026.24348
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Abstract

Background/Aims: Walled-off necrosis (WON) is a well-developed, enclosed accumulation of fluid, comprising a mixture of solid and liquid necrotic material, located within the pancreas and its surrounding area. Managing patients with asymptomatic WON is controversial due to limited information available about its natural history. The study aimed to determine the long-term natural course of WON in acute pancreatitis (AP) patients who remained asymptomatic and did not undergo any interventional treatment upon initial diagnosis.

Materials and Methods: Acute pancreatitis patients who were followed between June 2016 and December 2019 were retrospectively evaluated. Among them, patients who developed WON after the AP attack and did not undergo any therapeutic intervention upon initial diagnosis due to their asymptomatic course were enrolled in the study.

Results: The asymptomatic WON patients (n = 31) were followed up for a mean duration of 25.6 ±17.3 months. During the follow-up, 10 (32.3%) patients required interventional treatment within an average of 124.9 ± 189.5 days. Two patients died while under asymptomatic follow-up. In 12 patients (38.7%) WON disappeared; and in 7 (22.5 %) patients, mean size of the largest WON decreased from 64.7 ± 34.2 to 29.8 ± 27.4 mm. The extent of necrosis and the initial WON size were significantly higher in those requiring interventional treatment [AUC (area under the curve) were 0.844 and 0.733, respectively].

Conclusion: The management of WON usually includes close monitoring of the patient. The initial characteristics of WON (e.g., extent of necrosis, size, etc.) may aid in determining the necessity for drainage during the follow up of asymptomatic patients.

Cite this article as: Bektaş M, Acar Ş, Eminler AT, et al. Natural course of asymptomatic walled-off necrosis due to acute pancreatitis. Turk J Gastroenterol. 2026;37(4):420-429.

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Article Info
Published In
Journal Turkish Journal of Gastroenterology
Volume / Issue Volume 37 · Issue 4
Pages 420-429
DOI 10.5152/tjg.2026.24348
History
Published Online January 15, 2026
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright
Copyright (c) 2026 Melike Bektaş, Şencan Acar, Ahmet Tarık Eminler, Mukaddes Tozlu, Bilal Toka, Fuldem Mutlu, Mustafa İhsan Uslan, Erkan Parlak, Aydın Şeref Köksal
Affiliations
Melike Bektaş ORCID
Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Şencan Acar ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Ahmet Tarık Eminler ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Mukaddes Tozlu ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Bilal Toka
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Fuldem Mutlu ORCID
Department of Radiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Mustafa İhsan Uslan ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Erkan Parlak ORCID
Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
Aydın Şeref Köksal ORCID
Department of Gastroenterology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
Cite this Article
Bektaş, M., Acar, Şencan, Eminler, A. T., Tozlu, M., Toka, B., Mutlu, F., … Köksal, A. Şeref. (2026). Natural Course of Asymptomatic Walled-off Necrosis due to Acute Pancreatitis. Turkish Journal of Gastroenterology, 37(4), 420–429. https://doi.org/10.5152/tjg.2026.24348
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