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The TENSION trial compared immediate catheter drainage with a postponed step-up strategy for infected necrotizing pancreatitis. The delayed strategy allowed collections to mature before intervention, reflecting the principle that early procedures in critically ill patients may add harm without providing effective source control. The trial did not show a clear advantage for immediate drainage and supported the safety of waiting, when clinically appropriate, while providing intensive supportive treatment and intervening once there was a better-defined target. For surgeons and interventional teams, this is an important shift away from reflexive early procedures. Timing should be driven by clinical deterioration, infection control, collection maturity, organ failure and the feasibility of safe drainage rather than a calendar-based rule alone. The study also reinforces the need for close collaboration among gastroenterology, surgery, interventional radiology and critical care. In patients who are stable enough to wait, allowing encapsulation can make subsequent drainage or necrosectomy less invasive and technically more controlled. TENSION therefore complements the step-up philosophy established by earlier randomized evidence.
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The TENSION trial compared immediate catheter drainage with a postponed step-up strategy for infected necrotizing pancreatitis. The delayed strategy allowed collections to mature before intervention, reflecting the principle that early procedures in critically ill patients may add harm without providing effective source control. The trial did not show a clear advantage for immediate drainage and supported the safety of waiting, when clinically appropriate, while providing intensive supportive treatment and intervening once there was a better-defined target. For surgeons and interventional teams, this is an important shift away from reflexive early procedures. Timing should be driven by clinical deterioration, infection control, collection maturity, organ failure and the feasibility of safe drainage rather than a calendar-based rule alone. The study also reinforces the need for close collaboration among gastroenterology, surgery, interventional radiology and critical care. In patients who are stable enough to wait, allowing encapsulation can make subsequent drainage or necrosectomy less invasive and technically more controlled. TENSION therefore complements the step-up philosophy established by earlier randomized evidence.
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