The PENGUIN trial prospectively enrolled 20 patients with IPN; endoscopic transgastric necrosectomy was performed in 10 patients, and VARD or open necrosectomy was performed in another 10 patients.[7] The results showed that the former technique can further reduce the level of serum interleukin 6 and major complications, including new-onset multiple organ failure and pancreatic fistula. Here, IL6 is linked to bile duct papillary neoplasm.