Background Endoscopic debridement instruments used in acute necrotizing pancreatitis (ANP) may be associated with bleeding occurrence. Our study analyzed the incidence of bleeding in ANP patients undergoing endoscopic necrosectomy using different instruments.

Methods The subjects of this retrospective cohort study were patients who underwent endoscopic necrosectomy, including endoscopic percutaneous endoscopic necrosectomy (PEN) and transmural necrosectomy (ETN), at the First Affiliated Hospital of Nanchang University from January 2014 to December 2022. WE recorded bleeding events and the names of debridement instruments used during each endoscopic debridement procedure.

Results Our study included 446 ANP patients, of which 226 (50.7%) received PEN, 201 (45.1%) received TEN, and 19 (4.2%) received a combination of PEN and TEN. 969 endoscopic debridement procedures were performed on these patients, of which 175 (18.1%) had intraoperative bleeding. The incidence of bleeding was lowest with the use of a snare for debridement and highest with the use of grasping forceps (9.8% versus 24.4%, P < 0.05). Doctors with low bleeding rates often used snare during endoscopic necrosectomy, and those with high bleeding rates often used grasping forceps or in combination with other instruments (P < 0.01).

Conclusions Compared with the basket and grasping forceps, the use of a snare during endoscopic necrosectomy has a lower bleeding rate in patients with necrotizing pancreatitis.