Table of Contents
Overview
New York, NY – April 23, 2025 – Global Direct Endoscopic Necrosectomy Market size is expected to be worth around USD 369.8 Million by 2033 from USD 182.8 Million in 2023, growing at a CAGR of 7.3% during the forecast period from 2024 to 2033.
Direct Endoscopic Necrosectomy (DEN) is an advanced, minimally invasive procedure used to remove infected or necrotic pancreatic tissue in patients with walled-off pancreatic necrosis (WON), a serious complication of acute pancreatitis. This procedure has gained widespread adoption as a safer alternative to traditional surgical necrosectomy.
DEN is typically performed through endoscopic ultrasound (EUS) guidance, allowing precise access to the necrotic cavity via the stomach or duodenum. A stent is placed to create a direct conduit, enabling drainage and repeated endoscopic access for debridement. This approach minimizes trauma to surrounding tissues and significantly reduces post-procedure complications, hospital stays, and mortality rates.
Clinical studies have demonstrated high success rates with DEN, often exceeding 80%, and lower infection risks compared to open surgery. Patients benefit from faster recovery times, less pain, and fewer adverse events. DEN is increasingly integrated into multidisciplinary treatment protocols in tertiary care centers globally. With the global burden of acute pancreatitis rising, particularly due to alcohol consumption and gallstones, the demand for effective and less invasive interventions like DEN continues to grow. This procedure represents a major advancement in therapeutic endoscopy and personalized gastroenterological care.
Key Takeaways
- Market Size: The global Direct Endoscopic Necrosectomy market is projected to reach approximately USD 369.8 million by 2033, up from USD 182.8 million in 2023.
- Market Growth: The market is expected to grow at a compound annual growth rate (CAGR) of 7.3% during the forecast period from 2024 to 2033.
- Diagnosis Analysis: In 2023, abdominal scans emerged as the leading diagnostic method, accounting for 58.4% of the market share, due to their effectiveness in accurately identifying pancreatic necrosis and guiding treatment.
- Patient Disorder Analysis: Pancreatitis remained the primary disorder treated through direct endoscopic necrosectomy, representing 50.19% of the total patient cases in 2023, reflecting the high incidence and need for minimally invasive interventions.
- End-Use Analysis: Hospitals dominated the end-use segment in 2023, capturing 67% of the market share, driven by their capacity to handle complex procedures and provide comprehensive care.
- Regional Analysis: North America led the global market in 2023, holding a 39.5% share, supported by advanced healthcare infrastructure and early adoption of innovative endoscopic procedures.
- Rising Popularity of Outpatient Settings: Ambulatory Surgical Centers and specialty clinics are gaining momentum due to their cost efficiency and convenience for outpatient necrosectomy procedures.
- Technological Advancements: Ongoing innovations in endoscopic instruments and imaging technologies are improving the safety, precision, and effectiveness of necrosectomy, thereby driving increased adoption and market expansion.
Segmentation Analysis
- Diagnosis Analysis: In 2023, abdominal scans led the diagnostic segment with a 58.4% market share due to their precision and non-invasive nature. These scans enable clear visualization for effective treatment planning. Urine tests and abdominal biopsies also contributed significantly by supporting early detection and confirming necrosis histologically. The integration of these diagnostic methods ensures accurate assessments, helping guide direct endoscopic necrosectomy and improving patient outcomes through timely intervention and personalized treatment strategies.
- Patient Disorder Analysis: Pancreatitis dominated the Direct Endoscopic Necrosectomy Market in 2023, holding 50.19% share. The rise in severe pancreatitis cases has fueled demand for minimally invasive treatment like DEN, which allows direct removal of necrotic tissue. This procedure effectively addresses complications such as abdominal infections and pseudocysts. Its precision, reduced recovery time, and enhanced patient outcomes make DEN a preferred solution. Growing awareness and endoscopic advancements continue to support market expansion across gastrointestinal disorders.
- End-User Analysis: Hospitals held the largest share of 67% in 2023, driven by advanced infrastructure, skilled personnel, and the ability to manage high-risk cases. They remain the primary setting for complex procedures like DEN. Ambulatory Surgical Centers and specialty clinics are gaining traction due to cost-efficiency, shorter wait times, and outpatient care capabilities. Together, these facilities are expanding access to DEN, offering comprehensive and effective solutions for patients needing endoscopic necrosectomy.
Market Segments
Diagnosis
- Abdominal Scan
- Urine Test
- Abdominal Biopsy
Patient Disorder
- Pancreatitis
- Abdominal Pain
- Abdominal Infection
- Others
End-User
- Hospitals
- Ambulatory Surgical Centers
- Specialty Clinics
Regional Analysis
In 2023, North America led the Direct Endoscopic Necrosectomy Market with a 39.5% share. This dominance is primarily due to the region’s advanced healthcare infrastructure, widespread adoption of innovative medical technologies, and growing awareness of minimally invasive treatment options. The presence of top-tier medical institutions and highly skilled healthcare professionals has further supported the broad application of direct endoscopic necrosectomy.
Moreover, favorable government policies and significant investment in healthcare R&D continue to strengthen the region’s position. North America remains a key driver in advancing endoscopic solutions for pancreatic necrosis and related disorders.
Emerging Trends
- Adoption of Specialized Tools: The introduction of devices like the EndoRotor has improved the efficiency of DEN. This tool allows for simultaneous cutting and suction of necrotic tissue, reducing the need for multiple instruments and sessions. In a study involving 30 patients, the EndoRotor achieved a 97% success rate in removing at least 70% of necrotic debris per session.
- Preference for Larger Stents: Lumen-apposing metal stents (LAMS), especially those with diameters of 15 mm or more, are increasingly used. These larger stents facilitate better drainage and allow easier access for endoscopic tools, leading to faster resolution of WOPN.
- Improved Clinical Outcomes: DEN has shown higher clinical success rates compared to traditional surgical approaches. In one study, 85% of patients achieved clinical success with DEN, and the complication rate was 35%.
- Reduced Hospitalization: Patients undergoing DEN often experience shorter hospital stays. The median discharge time after DEN was reported as 10 days, compared to 14–29 days with conventional techniques.
- Multidisciplinary Approach: Managing WOPN with DEN often involves a team of specialists, including gastroenterologists, radiologists, and surgeons. This collaborative approach ensures comprehensive care and addresses potential complications effectively.
Use Cases
- Infected Walled-Off Pancreatic Necrosis: DEN is particularly effective for patients with infected WOPN. In a comparative study, 11 out of 12 patients treated with DEN achieved clinical resolution, whereas only 3 out of 12 patients treated with the step-up approach did.
- Minimally Invasive Alternative to Surgery: For patients who are high-risk surgical candidates, DEN offers a less invasive option. The procedure has been associated with fewer complications and a lower mortality rate compared to open surgical necrosectomy.
- Management of Recurrent Necrosis: DEN is also used in cases of recurrent WOPN. A hybrid technique combining endoscopic and radiological methods has been employed to manage complex cases effectively.
- Use in Pediatric Patients: While less common, DEN has been successfully performed in pediatric patients with WOPN, offering a safe and effective treatment option for this population.
- Integration with Advanced Imaging: The use of endoscopic ultrasound (EUS) guidance during DEN enhances the precision of the procedure, allowing for better visualization and targeting of necrotic tissue.
Conclusion
In conclusion, Direct Endoscopic Necrosectomy (DEN) represents a transformative advancement in the treatment of walled-off pancreatic necrosis. Its minimally invasive nature, high clinical success rates, and reduced complication risks make it a preferred alternative to traditional surgery. With growing demand driven by rising pancreatitis cases and ongoing technological innovation, DEN is increasingly integrated into multidisciplinary care pathways.
The procedure’s effectiveness in diverse settings from hospitals to outpatient centers—and its success in both adult and pediatric patients underscore its expanding clinical value. As awareness and access improve globally, DEN is poised to become a cornerstone of modern gastroenterological treatment.
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