Endoscopic Necrosectomy Versus Step-up Endoscopic Intervention

Inclusion criteria

• . The subject (or when applicable the subject's LAR) is capable of understanding and complying with protocol requirements
• . The subject (or when applicable the subject's LAR) is able to understand and willing to sign an informed consent form prior to the initiation of any study procedures
• . Males or females ≥ 18 years of age
• . Necrotic collection diagnosed on MRI or CT abdomen/pelvis (seen as a fluid collection in the setting of documented pancreatic necrosis that contains necrotic material and encased within a partial or complete wall)
• . Necrotic collection of any size with ≥ 33% of solid/necrotic component and any no. of loculations, located within the pancreatic/peri-pancreatic space
• . Necrotic collection visualized on EUS and amenable to EUS-guided drainage
• . Suspected/confirmed infected necrotic collection. Infected necrosis is defined by the presence of gas in the necrotic collection on cross-sectional imaging or positive culture of necrotic tissue obtained preprocedure or at first intervention. Infected necrosis is also suspected when sepsis is persistent or in the presence of ongoing clinical deterioration.
• . Documented history of acute pancreatitis Acute pancreatitis is diagnosed if 2 of the following 3 criteria are met

Exclusion criteria