Publication Name	World Journal of Gastrointestinal Endoscopy
Manuscript ID	116865
Country	Romania

Category	Gastroenterology & Hepatology
Manuscript Type	Editorial
Article Title	Between step-up and upfront intervention: Risk stratification as the missing link in timing endoscopic necrosectomy
Manuscript Source	Invited Manuscript
All Author List	Ana-Maria Singeap, Stefan Chiriac, Horia Minea and Anca Trifan
Funding Agency and Grant Number
Corresponding Author	Stefan Chiriac, Assistant Professor, Department of Gastroenterology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Bd. Independentei 1, Iasi 700115, Romania. stefannchiriac@yahoo.com
Key Words	Walled-off necrosis; Endoscopic necrosectomy; Risk stratification; Endoscopic step-up approach; Passive drainage failure; Personalized intervention
Core Tip	This article highlights the importance of the recently published study by Lone et al, which identifies key clinical, biochemical, and imaging predictors of passive drainage failure in patients with walled-off pancreatic necrosis. By demonstrating that factors such as necrosis extent, persistent inflammation, and poor nutritional reserve can predict the need for direct endoscopic necrosectomy, the study shifts the focus from a time-based step-up protocol toward a risk-based, individualized approach. These findings underscore that in walled-off pancreatic necrosis management, the key question is not when to intervene, but in whom waiting may be riskier than acting.
Citation	Singeap AM, Chiriac S, Minea H, Trifan A. Between step-up and upfront intervention: Risk stratification as the missing link in timing endoscopic necrosectomy. World J Gastrointest Endosc 2026; In press

Received	2025-11-24 04:07
Peer-Review Started	2025-11-24 04:07
First Decision by Editorial Office Director	2025-12-12 08:39
Return for Revision	2025-12-12 08:39
Revised	2025-12-24 20:38
Publication Fee Transferred
Second Decision by Editor	2026-01-13 02:36
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-01-13 07:13
Articles in Press	2026-01-13 07:13
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-5190 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
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