latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). In this study, we aimed to\ndescribe a novel step-up approach for treating IPN consisting of four steps including negative pressure irrigation\n(NPI) and endoscopic necrosectomy (ED) as a bridge between percutaneous catheter drainage (PCD) and open\nnecrosectomy\nMethods: A retrospective review of a prospectively collected internal database of patients with a diagnosis of IPN\nbetween Jan, 2012 to Dec, 2012 at a single institution was performed. All patients underwent the same drainage\nstrategy including four steps: PCD, NPI, ED and open necrosectomy. The demographic characteristics and clinical\noutcomes of study patients were analyzed.\nResults: A total of 71 consecutive patients (48 males and 23 females) were included in the analysis. No significant\nprocedure-related complication was observed and the overall mortality was +21.1 % (15 of 71 patients). Seven\ndifferent strategies like PCD+ NPI, PCD+NPI+ED, PCD+open necrosectomy, etcetera, were applied in study patients\nand a half of them received PCD alone. In general, each patient underwent a median of 2 drainage procedures and\nthe median total drainage duration was 11 days (interquartile range, 6ââ?¬â??21days).\nConclusions: This four-step approach is effective in treating IPN and adds no extra risk to patients when compared\nwith other latest step-up strategies. The two novel techniques (NPI and ED) could offer distinct clinical benefits\nwithout posing unanticipated risks inherent to the procedures.
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