Minimally Invasive Surgery vs. Endoscopy Randomized (MISER) Trial for Necrotizing Pancreatitis

Inclusion Criteria: * Necrotic collection * Infected (suspected and confirmed): clinical signs of infection (septic, positive cultures, febrile), systemic inflammatory response syndrome, gas within the collection on imaging (not iatrogenic), or positive culture of collection contents * Necrotic collection is within 15mm of the lumen of the gastrointestinal tract. * 18 years and older * Informed consent obtained from the patient or their medical representative. * Medically fit for general anesthetic * Collection amenable to either endoscopic or minimally invasive surgical necrosectomy and drainage. Exclusion Criteria: * \<18 years old * Unable to obtain informed consent from the patient or their medical representative. * Medically unfit for general anesthesia * Pregnant * Necrotic collection not accessible by either or both techniques * The collection is \>15mm from the lumen of the gastrointestinal tract. * Irreversible coagulopathy: International Normalized Ratio (INR) \>1.5 * Irreversible thrombocytopenia: platelet count \<50 x10\^9/L * Dual antiplatelet therapy or therapeutic anticoagulation that cannot be withheld for the procedure * Surgical or endoscopic necrosectomy or pseudocyst drainage has been performed within the preceding 12 months * Necrotic collection secondary to trauma or other surgical event that requires additional interventions such as management of liver lacerations or vascular injury. * Pre-existing percutaneous drain