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Minimal-invasive treatment options, such as endoscopic necrosectomy, may decrease peri-interventional morbidity and mortality. This study aims to compare the initial operative with endoscopic treatment on long-term parameters, such as endocrine and exocrine functionality, as well as mortality and recurrence rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 114 patients, of whom 69 were treated with initial endoscopy and 45 by initial surgery. Both groups were further assessed for peri-interventional and long-term parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the post-interventional phase, patients in the group of initial surgical treatment (IST) showed significantly higher rates of renal insufficiency (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and dependency on invasive ventilation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The in-house mortality was higher in the surgical group, with 22% vs. 10.1% in the group of patients following initial endoscopic treatment (IET;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.077). In long-term follow-up, the overall mortality was 45% for IST and 31.3% for IET (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.156). The overall in-hospital stay and intensive care unit (ICU) stay were significantly shorter after IET (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In long-term follow-up, the prevalence of endocrine insufficiency was 50% after IST and 61.7% after IET (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.281). 57.1% of the patients following IST and 16.4% of the patients following IET had persistent exocrine insufficiency at that point (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\u2009&lt;\u20090.001). 8.9% of the IET and 27.6% of the IST patients showed recurrence of acute pancreatitis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023) in the long-term phase.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our cohort, an endoscopic step-up approach led to a reduced in-hospital stay and peri-interventional morbidity. The endocrine function appeared comparable in both groups, whereas the exocrine insufficiency seemed to recover in the endoscopic group in the long-term phase. These findings advocate for a preference for endoscopic treatment of acute necrotizing pancreatitis whenever feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-024-03244-9","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T16:02:46Z","timestamp":1707753766000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Endoscopic and surgical treatment of necrotizing pancreatitis\u2014a comparison of short- and long-term outcome"],"prefix":"10.1007","volume":"409","author":[{"given":"Lea","family":"Timmermann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svenja","family":"Sch\u00f6nauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Herbert","family":"Hillebrandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matth\u00e4us","family":"Felsenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Pratschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Malinka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"J\u00fcrgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"issue":"7","key":"3244_CR1","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1053\/j.gastro.2019.01.269","volume":"156","author":"G Trikudanathan","year":"2019","unstructured":"Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG (2019) Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. 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Lea Timmermann, Svenja Sch\u00f6nauer, Dr. med. Karl Herbert Hillebrandt, Dr. med. Matth\u00e4us Felsenstein and Dr. med. Christian J\u00fcrgensen have no con-flicts of interest or financial ties to disclose. Prof. Dr. Johann Pratschke reports personal fees or non-financial support from Johnson &; Johnson, DP Medsystems, Medtronic GmbH, Navigant, Falk Foundation, CHG Meridian, Noggo, Astellas, Promedicis, La Fourse Group, Merck Serono GmbH, Neovii, Chiesi, Med Tech, pharma-consult Peterson, I\u2009+\u2009E-research, Exafield GmbH, Euro-transplant, Intuitive, Biba Group, DSO, DTG, ESOT, \u00d6CK, UEG, ESOT and Fraunhofer Institut. Prof. Dr. Thomas Malinka reports on other support from Intuitive Surgical Deutschland GmbH.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"58"}}