Background Necrotizing pancreatitis with infected necrotic tissue is associated with a high
rate of complications and death. Standard treatment is open necrosectomy. The outcome
may be improved by a minimally invasive step-up approach. Methods In this multicenter
study, we randomly assigned 88 patients with necrotizing pancreatitis and suspected or
confirmed infected necrotic tissue to undergo primary open necrosectomy or a step-up
approach to treatment. The step-up approach consisted of percutaneous drainage followed …

To the Editor: The results from the study by van Santvoort et al.(Minimally Invasive Step-up
Approach versus MaximalNecrosectomy in Patients with Acute Necrotizing Pancreatitis
[PANTER])(April 22 issue) 1 show that percutaneous drainage (PCD) alone is a valuable
strategy in selected patients, helping to avoid the need for surgery in 40% of step-up
patients. The reduced morbidity associated with the procedure may largely be due to the
avoidance of harm from surgery: when PCD-only patients are not considered, the …