Has the Step-Up Approach Improved Prognosis in Severe Necrotizing Acute Pancreatitis?
Ricardo Gadea-Mateo1, Marina Garcés-Albir2, Dimitri Dorcaratto2
1Department of Surgery, Hospital Clínico Universitario of Valencia, Biomedical Research Institute INCLIVA, University of Valencia, 46010 Valencia, Spain.
Journal of Clinical Medicine
|May 4, 2026
Summary
Implementing a step-up approach for severe acute pancreatitis (SAP) reduced open surgeries and hospital stays. While effective, Video-Assisted Retroperitoneal Debridement (VARD) for SAP showed higher fistula rates than endoscopic necrosectomy.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Outcomes Research
Background:
- Severe acute pancreatitis (SAP) presents significant morbidity and mortality despite treatment advances.
- Increasing incidence of acute pancreatitis necessitates optimized management strategies.
- Tertiary referral centers face challenges in managing SAP cases effectively.
Purpose of the Study:
- To evaluate the impact of a step-up management strategy on clinical outcomes in SAP patients.
- To compare outcomes between classical treatment and a step-up approach.
- To analyze minimally invasive techniques in SAP management.
Main Methods:
- Retrospective observational study comparing two treatment periods (classical vs. step-up).
- Inclusion of 116 patients with SAP treated at a tertiary care center.
- Subanalysis of minimally invasive techniques, including endoscopy and VARD.
Main Results:
- The step-up approach significantly decreased open surgeries (71.9% vs. 16.9%) and mean hospital stay (60.5 to 33.08 days).
- Mortality and pancreatic fistula rates showed a trend of reduction with the step-up approach.
- VARD was associated with higher pancreatic fistula rates (57.1%) compared to endoscopic necrosectomy (0%) in Period B.
Conclusions:
- The step-up management strategy is linked to reduced open surgical interventions and shorter hospital stays for SAP.
- VARD is indicated for larger collections but carries a higher risk of pancreatic fistulas than endoscopic necrosectomy.
- Further research into optimizing minimally invasive techniques for SAP is warranted.
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