A Step-up Approach, or Open Necrosectomy for Necrotizing Pancreatitis

To the Editor: The results from the study by van Santvoort et al. (Minimally Invasive Step-up Approach versus Maximal Necrosectomy 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 complication rate appears to be similar in the two study groups. Moreover, PCD was often inadequate, leading to a delay . . .