Background/Aims: Necrotizing pancreatitis has morbidity and mortality rates exceeding most of the other acute medical emergenciesdespite the best possible medical and surgical care. Early surgical intervention has a high operative risk.Materials and Methods: This prospective open-label study was designed to evaluate the role of percutaneous catheter drainage (PCD)of pancreatic necrosis as primary treatment of acute necrotizing pancreatitis. An ultrasound/computed tomography-guided drainagewas performed with 10 or 12 Fr catheters using a 0.35 mm guide wire, irrespective of whether necrosis was infected or not. Patients werefollowed up for organ dysfunction, need for surgical intervention, and survival at week 8.Results: A total of 20 (65% males) patients who had acute necrotizing pancreatitis with varied etiology were enrolled in the presentstudy. Of these patients, 9 (45%) did not need surgery after PCD. The remaining 11 (55%) patients showed significant reversal of organfailure after PCD insertion (p<0.05 for improvement in serum creatinine, need for mechanical ventilation, and decline in C-reactive protein). Survival at week 8 was 95%. PCD was well tolerated with only two catheter-related complications being observed.Conclusion: Percutaneous catheter drainage can be a primary treatment option for necrotizing pancreatitis. In addition, it helps to stabilize critically ill patients and delay the surgical procedure to beyond 4 weeks to improve the surgical outcomes.