Authors reply: treatment strategy for necrotising pancreatitis

We thank the authors for their interest in our randomised trial.1 2 First, the patient population: The treatment algorithm outlined in our study is different from the TENSION trial and other preceding trials from the Netherlands.3 In patients with large collections (>120 mm in size), the multigate technique was adopted (20% of patient cohort). In patients with persistent or ongoing systemic inflammatory response syndrome (SIRS) after initial drainage, a CT scan was obtained at 72 hours to assess treatment response. If there was <25% decrease in size of the necrotic collection, then additional interventions were undertaken (another 40% of patient cohort): more drainage tracts were created or necrosectomy was performed depending on contents of the necrotic cavity and/or percutaneous drains were placed. In essence, 60% of study cohort required advanced/additional interventions. We believe that necrosectomy was not required, not because the study population constituted a different patient subset, but because...

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