[Endoscopic versus surgical treatment of infected necrotising pancreatitis: the TENSION study]

In patients with infected necrotising pancreatitis there is a significant risk (40%) of complications and mortality with the surgical step-up approach. This approach consists of percutaneous retroperitoneal drainage, if necessary followed by video-assisted retroperitoneal débridement. An alternative treatment is an endoscopic step-up approach consisting of endoscopic transluminal drainage, if necessary followed by endoscopic transluminal necrosectomy. The Dutch Pancreatitis Study Group has recently started the nationwide randomized TENSION-trial, in which in 98 patients the endoscopic step-up approach is compared with the surgical method. The primary endpoint is a composite of mortality and major morbidity (new onset organ failure, bleeding, perforation of a hollow organ or incisional hernia for which intervention is needed).