The incidence of acute pancreatitis continues to rise, inducing substantial medical and social burden, with annual costs exceeding two billion dollars in the USA alone. Although the majority of patients develop mild pancreatitis, 20% develop severe and/or necrotizing pancreatitis, requiring advanced medical and interventional care. Morbidity resulting from local and systemic complications as well as invasive interventions result in mortality rates historically as high as 30%. There has been substantial evolution of strategies for interventions in recent years, from open surgery to minimally invasive surgical and endoscopic step-up approaches.