What type of study is this?

This is a Pre-Registered Trial study.

What question did this study set out to answer?

This research aims to explore the relationship between encapsulation of walled-off necrosis and clinical outcomes following pancreatitis.

February 22, 2026

Reply to Vanella et al.

Key Points

This research aims to explore the relationship between encapsulation of walled-off necrosis and clinical outcomes following pancreatitis.
Retrospective review of computed tomography images by a radiologist and gastroenterologist
Assessment of encapsulation based on maturation of WON wall defined by margin size
Comparison of traditional image interpretation with AI diagnostic platforms
Encapsulation degree showed a stronger association with clinical outcomes than elapsed time since pancreatitis onset
High concordance rate of 88% in image interpretation between specialists
Need for standardized encapsulation definitions emphasized, along with further investigation into QNI criteria

Abstract

1055/a-2749-8235 We wish to thank Vanella et al. for their valuable comments on our research. Although our study suggests that the clinical outcomes of walled-off necrosis (WON) were more strongly associated with the degree of encapsulation than with the time elapsed since the onset of pancreatitis, there are some limitations owing to its retrospective nature. The definition of encapsulation has not been well standardized, and we defined the maturation of a WON wall as the presence of a discrete enhanced margin of ≥1 mm of the WON, with complete and partial/no encapsulation being defined by the maturation of ≥80% and <80% of the wall, respectively. Computed tomography (CT) images were retrospectively reviewed by both a radiologist and a gastroenterologist, and we had a relatively high concordance rate of 88%; however, we did encounter discrepancies in the image interpretation in cases with uneven encapsulation. The interpretation by gastroenterologists may be less accurate than that by radiologists, who have good access to working stations for CT images. A standardized definition of encapsulation needs to be established to further investigate its role in the management of WON. In addition, artificial intelligence-based diagnostic platforms could help with the accurate and objective interpretations of gastroenterologists, who mainly manage WON in clinical practice. As Baroud and colleagues advocated, other clinical parameters, including the Quadrant-Necrosis-Infection (QNI) criteria 1 , should be investigated in combination with encapsulation levels for a better prediction of clinical outcomes. Because this was a hypothesis-generating study, our WONDERDUL group is currently conducting a randomized controlled trial comparing timing-oriented and encapsulation-oriented endoscopic ultrasound-guided drainage for WON (ClinicalTrials.gov NCT07106346), and we hope the study results will further demonstrate the importance of encapsulation in the management of WON. Article published online: 20 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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Cite This Study

Maruta et al. (Fri,) studied this question.

synapsesocial.com/papers/699a534bfdaf4e3c1268ed71 https://doi.org/https://doi.org/10.1055/a-2764-1669

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