Direct Endoscopic Necrosectomy Market Shows Robust Growth Outlook Through 2033 at 7.3% CAGR

Overview

New York, NY – Feb 03, 2026 – The 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 endoscopic procedure used for the management of walled-off pancreatic necrosis, a serious complication of acute necrotizing pancreatitis. The procedure has been increasingly adopted due to its clinical effectiveness and reduced patient burden compared with traditional surgical approaches.

DEN is performed using a flexible endoscope that is passed through the gastrointestinal tract to access the necrotic pancreatic collection, usually via a transmural route from the stomach or duodenum. Under endoscopic and imaging guidance, a lumen-apposing metal stent is placed to create a stable channel between the gastrointestinal lumen and the necrotic cavity. This access allows direct visualization and stepwise removal of necrotic tissue using endoscopic accessories.

The procedure is typically conducted in multiple sessions to ensure gradual and safe debridement. DEN has been associated with high technical and clinical success rates, shorter hospital stays, and lower morbidity when compared with open surgical necrosectomy. The minimally invasive nature of the procedure contributes to faster recovery and improved patient outcomes.

The growing use of Direct Endoscopic Necrosectomy reflects broader trends toward endoscopy-led management of complex pancreatic diseases. Ongoing advancements in endoscopic tools and techniques are expected to further improve procedural safety, efficiency, and clinical outcomes, supporting DEN as a standard of care in appropriately selected patients.

Key Takeaways

• Market Size: The global Direct Endoscopic Necrosectomy market is projected to reach approximately USD 369.8 million by 2033, increasing from USD 182.8 million in 2023.
• Market Growth: The market is expected to expand at a compound annual growth rate (CAGR) of 7.3% over the forecast period from 2024 to 2033.
• Diagnosis Analysis: Strong growth has been observed in the Direct Endoscopic Necrosectomy market, with abdominal imaging scans accounting for 58.4% of the total market share in 2023.
• Patient Disorder Analysis: In 2023, pancreatitis represented the leading clinical indication, contributing 50.19% of the overall market share.
• End-Use Analysis: Hospitals remained the primary end users in 2023, capturing approximately 67% of the global market share.
• Regional Analysis: North America led the global Direct Endoscopic Necrosectomy market in 2023, holding a dominant 39.5% share.
• Rising Popularity: Ambulatory surgical centers and specialty clinics are increasingly being adopted, driven by their cost efficiency and suitability for outpatient-based procedures.
• Technological Advancements: Ongoing advancements in endoscopic devices and techniques are improving procedural accuracy, safety, and overall clinical outcomes in necrosectomy procedures.

Regional Analysis

In 2023, North America emerged as the leading region in the Direct Endoscopic Necrosectomy market, accounting for approximately 39.5% of the global market share. This strong market position is primarily driven by the region’s well-established healthcare infrastructure, high penetration of advanced medical technologies, and growing preference for minimally invasive therapeutic procedures. Increased clinical awareness and early adoption of innovative endoscopic solutions have supported the widespread use of direct endoscopic necrosectomy across the region.

Furthermore, the presence of advanced medical centers and a highly trained pool of healthcare professionals has facilitated the consistent integration of this procedure into standard clinical practice. Favorable regulatory frameworks, along with sustained public and private investments in healthcare research and development, have also contributed to continued market expansion.

The dominant position of North America highlights its critical role in the development and adoption of advanced endoscopic interventions, reinforcing the region’s leadership in the treatment of pancreatic necrosis and associated gastrointestinal disorders.

Emerging Trends

• Adoption of Specialized Endoscopic Tools: The use of dedicated devices such as the EndoRotor has enhanced the procedural efficiency of direct endoscopic necrosectomy (DEN). The device enables simultaneous mechanical debridement and suction of necrotic tissue, reducing instrument exchanges and the number of required sessions. Clinical evidence from a 30-patient study indicated that at least 70% of necrotic material was removed per session in 97% of cases.
• Increasing Use of Larger-Diameter Stents: Lumen-apposing metal stents (LAMS), particularly those with diameters of 15 mm or greater, are increasingly preferred in DEN procedures. Larger stents improve drainage capacity and provide easier endoscopic access to the necrotic cavity, contributing to more rapid resolution of walled-off pancreatic necrosis (WOPN).
• Improved Clinical Effectiveness: DEN has demonstrated superior clinical success when compared with conventional surgical interventions. Reported data indicate clinical success rates of approximately 85%, with an associated complication rate of 35%, supporting its role as an effective therapeutic approach.
• Reduction in Hospital Length of Stay: Patients treated with DEN typically experience shorter hospitalizations. Median discharge time following DEN has been reported at approximately 10 days, compared with 14 to 29 days for traditional surgical or step-up approaches.
• Growth of Multidisciplinary Care Models: Management of WOPN using DEN increasingly involves coordinated care among gastroenterologists, interventional radiologists, and surgeons. This multidisciplinary strategy supports comprehensive patient management and timely handling of procedure-related complications.

Key Use Cases

• Treatment of Infected Walled-Off Pancreatic Necrosis: DEN is particularly effective in cases of infected WOPN. Comparative clinical data show resolution in 11 out of 12 patients treated with DEN, whereas only 3 out of 12 patients achieved resolution using a step-up treatment approach.
• Minimally Invasive Option for High-Risk Patients: For patients with elevated surgical risk, DEN provides a minimally invasive alternative to open necrosectomy. The approach is associated with lower complication rates and reduced mortality when compared with conventional surgical management.
• Management of Recurrent or Complex Necrosis: DEN is also applied in recurrent WOPN cases. Hybrid approaches combining endoscopic and radiologic techniques have been successfully used to manage anatomically complex or refractory necrotic collections.
• Application in Pediatric Patients: Although less frequently performed, DEN has been safely and effectively utilized in pediatric patients with WOPN, expanding its applicability across age groups.
• Integration with Advanced Imaging Techniques: The incorporation of endoscopic ultrasound (EUS) guidance has improved procedural accuracy during DEN. Enhanced visualization allows precise targeting of necrotic tissue, supporting safer and more effective debridement.

Frequently Asked Questions on Direct Endoscopic Necrosectomy

• What is Direct Endoscopic Necrosectomy?
  Direct endoscopic necrosectomy is a minimally invasive endoscopic procedure used to remove infected or symptomatic pancreatic necrosis. It is performed through a transluminal route, reducing surgical trauma, hospital stay, and overall complication rates.
• When is Direct Endoscopic Necrosectomy recommended?
  Direct endoscopic necrosectomy is recommended in patients with walled-off pancreatic necrosis causing infection, persistent pain, or organ dysfunction. The procedure is generally considered after conservative management fails and the necrotic collection matures.
• What are the clinical benefits of Direct Endoscopic Necrosectomy?
  The benefits of direct endoscopic necrosectomy include lower morbidity, reduced need for open surgery, faster patient recovery, and improved clinical outcomes. The approach also allows repeated sessions with controlled removal of necrotic tissue.
• What risks are associated with Direct Endoscopic Necrosectomy?
  Potential risks associated with direct endoscopic necrosectomy include bleeding, perforation, infection, and stent-related complications. However, when performed by experienced specialists, the procedure demonstrates a favorable safety profile compared to surgical alternatives.
• What factors are driving growth in the Direct Endoscopic Necrosectomy market?
  The growth of the direct endoscopic necrosectomy market is driven by rising incidence of acute pancreatitis, increasing preference for minimally invasive procedures, technological advancements in endoscopic devices, and expanding adoption across tertiary care hospitals globally.
• Which healthcare settings primarily adopt Direct Endoscopic Necrosectomy?
  Direct endoscopic necrosectomy is primarily adopted in advanced hospitals and specialized gastroenterology centers. These settings possess the required endoscopic infrastructure, skilled professionals, and multidisciplinary support necessary for managing complex pancreatic necrosis cases.
• How does technology influence the Direct Endoscopic Necrosectomy market?
  Technological innovation significantly influences the direct endoscopic necrosectomy market through improved lumen-apposing metal stents, enhanced endoscopic imaging, and dedicated necrosectomy tools. These advancements improve procedural efficiency, safety, and overall treatment success rates.

Conclusion

Direct Endoscopic Necrosectomy has emerged as a clinically effective and minimally invasive standard for managing walled-off pancreatic necrosis. The procedure offers clear advantages over traditional surgical approaches, including higher clinical success rates, reduced hospitalization, and lower patient morbidity.

Market growth is being supported by rising pancreatitis incidence, technological advancements in endoscopic tools, and expanding adoption across hospitals and specialized centers. North America continues to lead due to strong healthcare infrastructure and early technology adoption. Overall, continued innovation and multidisciplinary clinical integration are expected to further strengthen the role of DEN in pancreatic disease management.