Necrotizing pancreatitis with infection is a complicated disease to manage, with high morbidity and mortality regardless of treatment. This excellent RCT from the New England Journal of Medicine demonstrates that the ‘minimally invasive step-up approach’ is a viable alternative to open necrosectomy that offers a far lower rate of complications.

van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502.