From the editor — February 2026
Editor’s note — This is the online edition of the February 2026 newsletter — the first issue of EUS & ERCP Monthly. Comments are open at the bottom of the page for any reflections, counter-evidence, or questions on the featured papers.
February’s most important contribution is the WONDER-01 randomised controlled trial in Gastroenterology — the first RCT to address the timing of direct endoscopic necrosectomy in symptomatic necrotising pancreatitis. Immediate necrosectomy reaches clinical resolution roughly 15 days sooner without a statistically significant increase in adverse events. There is also important new data comparing EUS-guided biliary drainage against percutaneous drainage after failed ERCP, with survival implications that belong in every MDT conversation. Seventy-one EUS and ERCP papers published this month; five are featured below, eight more are listed.
— Dr Venkat Mahesh, MRCP, FEBGH — Education & Media Lead, UKIEUS
Top 5 featured papers — February 2026
#1 — WONDER-01: Immediate endoscopic necrosectomy reaches clinical resolution 15 days faster than step-up drainage
Score 93/100 · RCT
Saito T, Nakai Y et al. 70 patients, 20 centres. Gastroenterology 2026. DOI: 10.1053/j.gastro.2026.01.034
The WONDER-01 trial randomised 70 patients to immediate DEN versus step-up drainage. Time to clinical success: median 29 vs 44 days (p=0.009). Adverse events comparable (24% vs 22%), mortality not significantly different.
Contextualising evidence. A contemporaneous Iranian RCT (Mohamadnejad et al., CGH 2026, n=50) found no superiority of immediate DEN and more moderate-to-severe adverse events in the immediate arm (16% vs 0%), with 44% of the on-demand group resolving without any necrosectomy at all. A 2025 meta-analysis of 15 studies (1,290 patients, Yuen et al., Dig Endosc) found no significant difference in clinical success or adverse events between approaches. Selective adoption with morphological risk-stratification is more defensible than blanket policy change.
Clinical bottom line. Immediate DEN shortens recovery significantly. Integrate CT morphology risk-stratification — particularly paracolic extension and solid debris content — before deciding on approach.
#2 — Prophylactic antibiotics for EUS-GE and EDGI: no infection benefit across 263 patients
Score 62/100 · Multicentre retrospective
Boortalary T et al. 263 patients, 5 centres. Gastrointestinal Endoscopy 2026. DOI: 10.1016/j.gie.2026.02.023
Antibiotic prophylaxis (given in 58.9%) did not significantly reduce transient signs of infection (17.4% vs 12.0%, p=0.23) or persistent infection (4.5% vs 3.7%, p=1.00). Length of stay and readmission rates also equivalent across five independent centres. A prospective RCT remains the definitive next step.
Clinical bottom line. Consider reviewing your unit’s default antibiotic policy for EUS-GE and EDGI.
#3 — EUS-BD confers +39.6 days six-month survival advantage over PTBD after failed ERCP
Score 60/100 · Retrospective cohort
Ciesielski W et al. 101 patients. Cancers (Basel) 2026. DOI: 10.3390/cancers18050783
Median overall survival: EUS-BD 143 vs PTBD 54 days (p=0.012), RMST +39.6 days at 6 months (95% CI 11.3–65.9). EUS-BD carried more major complications at this single centre (Clavien-Dindo ≥III: 10.8% vs 0%, p=0.02), likely reflecting a learning-curve effect.
Contextualising evidence. The de Jong multicentre prospective registry (Endoscopy 2025) showed fewer adverse events with EUS-CDS vs PTBD at experienced centres (44% vs 92%, p=0.004), and the ASGE 2024 guideline gave a conditional recommendation for EUS-BD over PTBD after failed ERCP. Both the survival data and centre expertise belong in the MDT discussion.
Clinical bottom line. EUS-BD appears to confer meaningful survival advantage over PTBD after failed ERCP. Safety depends on centre expertise — an MDT decision, not a unilateral one.
#4 — Three factors predict re-intervention after EUS-guided walled-off necrosis drainage
Score 46/100 · Prediction model
Jagtap N et al. 500 patients. Indian J Gastroenterol 2026. DOI: 10.1007/s12664-025-01935-9
Re-intervention in 24%. Three independent predictors: WON size (OR 1.38/cm), paracolic gutter extension (OR 9.96 — near-tenfold increase in risk), solid debris content (OR 1.10/%). AUC 0.85, 86.7% validation accuracy. Paracolic extension is directly actionable: review CT for this feature before drainage.
Clinical bottom line. Paracolic extension carries near-tenfold re-intervention risk — identify it before drainage and plan IR/surgical backup proactively.
#5 — EUS in pancreatic neuroendocrine tumours: from diagnosis to EUS-guided ablation
Score 45/100 · Systematic review
Bruni A et al. Bologna. J Gastroenterol Hepatol 2026. DOI: 10.1111/jgh.70302
EUS provides highest diagnostic yield for PanNETs under 20mm. Reviews CE-EUS characterisation, FNB vs FNA for Ki-67, and EUS-RFA (15–20% AE rate, high radiological control in small insulinomas). Key nuance: FNB still underestimates final histological grade in a meaningful proportion, directly affecting the surgery vs surveillance decision.
Clinical bottom line. FNB outperforms FNA for PanNET grading, but preoperative Ki-67 still underestimates final grade — factor this into the surgical decision conversation.
Also published — February 2026
1. [Therapeutic EUS] EUS-guided pancreatic duct drainage meta-analysis (27 trials, 902 patients). Technical success 89%, clinical success 88%. EUS-PDD outperforms enteroscopy-assisted access in surgically altered anatomy. Yamashita Y & Kitano M. Ther Adv Gastroenterol 2026. DOI: 10.1177/17562848261419936
2. [ERCP] ERCP timing does not independently predict survival in periampullary cancer (594 patients). Important negative finding. Cholangitis at presentation, age, metastatic stage and ERCP technical success are what matter. Dupont B et al. Ther Adv Gastroenterol 2026. DOI: 10.1177/17562848261426095
3. [Therapeutic EUS] Parallel-LAMS septotomy for durable partial reversal of Roux-en-Y gastric bypass. n=6, 100% success at 24-week follow-up without indwelling stents. Kadkhodayan K et al. GIE 2026. DOI: 10.1016/j.gie.2026.02.010
4. [AI / EUS diagnostic] AI plus radiomics on EUS images distinguishes insulinomas from non-functioning PanNETs. Proof-of-concept. Single centre. Mo S et al. BMC Med Inform Decis Mak 2026. DOI: 10.1186/s12911-026-03388-2
5. [Case report] EUS-guided antegrade stone removal 11 years after Whipple. EUS-TASR for choledocholithiasis with uneventful recovery. Li YM et al. World J Gastroenterol 2026. DOI: 10.3748/wjg.v32.i8.116856
6. [EUS-FNB] EUS-FNB for mediastinal pathologies: 94.8% adequate tissue yield without ROSE. 77 patients, 22G Franseen needle. TB was second most common diagnosis (14%). Karim MM et al. World J Gastrointest Endosc 2026. DOI: 10.4253/wjge.v18.i2.113699
7. [EUS diagnostic] EUS vs MSCT for GISTs: EUS superior on all diagnostic metrics. 94.9% vs 88.1% sensitivity; 90% vs 68% localisation accuracy. Use EUS first, MSCT for staging. Zhang Q et al. Int J Gen Med 2026. DOI: 10.2147/IJGM.S566099
8. [Review] Role of endoscopy in malignant biliary obstruction. Accessible strategy review. UK author: B Imran (University of Exeter). Vohra I, Imran B et al. Diagnostics (Basel) 2026. DOI: 10.3390/diagnostics16050721
Discussion thread — February 2026 issue. Comments are open below for any reflections, counter-evidence from your own practice, or questions on these papers. The WONDER-01 timing debate and the EUS-BD-vs-PTBD survival data are both ones I’d genuinely like to hear UK perspectives on.
— VM
© UKIEUS 2026. Editorial commentary by Dr Venkat Mahesh, MRCP, FEBGH. Paper titles and abstracts cited from PubMed with DOI attribution; no copyrighted full text reproduced. Primary literature identified via PubMed systematic search; broader clinical context verified through structured evidence synthesis; all references independently confirmed via PubMed prior to inclusion. For educational use only. www.ukieus.co.uk
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