Immediate endoscopic necrosectomy (den) after drainage significantly speeds recovery in patients with necrotizing pancreatitis.

• Time to clinical success was 29 days with immediate den, compared to 44 days with the step-up approach (p = .009).
• Adverse events were similar between groups: 24% for immediate den vs. 22% for step-up (p = .79).

Consider immediate den for faster patient recovery without increased risk.

• Technical success rates were high and comparable: 100% for immediate den vs. 97% for step-up (p > .99).