Step-up approach for severe acute necrotizing pancreatitis

Severe acute pancreatitis accounts for 20% of cases, and pancreatic necrosis and infection significantly increase morbidity and mortality. The estimated mortality for infected necrosis without organ failure is around 1.4%, for necrosis without infection with organ failure it is 19.8% and for infected necrosis with organ failure it is 35.2%. The currently accepted management approach is the step-up approach; however, there is disagreement regarding the best approach and protocol options. The Step-Up approach offers good results, but it must be adapted to each case and center to make its results reproducible. Our aim is to discuss the importance of adapting the protocol to the individual needs of each case.