Background and Aims Acute necrotizing pancreatitis (ANP) is a complex and variable condition with diverse pathological progressions, and the mortality rate can reach 20% to 30% when secondary infections occur. Currently, the treatment for ANP mainly involves early symptomatic management, such as fasting, fluid infusion, pain relief, acid suppression, and enzyme inhibition, followed by a step-up approach involving surgical interventions when complications develop in the later stages. Late-stage local complications of ANP are associated with a high incidence complications and poor prognosis. Studies have suggested that pancreatic duct hypertension and obstruction play crucial roles in the pathogenesis of acute pancreatitis (AP), with a probability of pancreatic fluid leakage exceeding 90%. Therefore, this study investigated the efficacy and safety of early pancreatic duct stent placement in treating ANP.Methods Clinical data of ANP patients who underwent pancreatic duct stent placement within 48 h of admission at Ningxia Medical University General Hospital from June 1, 2019, to December 30, 2021, were retrospectively collected.Results According to the inclusion and exclusion criteria, 57 patients were included, including 34 with moderately severe disease and 23 with severe disease. The median time from admission to surgery for all patients was 8 (3-21) h, and all patients successfully underwent pancreatic duct stent placement. Pancreatic protein plugs were observed in 18 patients during surgery, including 8 cases (23.53%) with moderately severe disease and 10 cases (43.48%) with severe disease. Patients had varying degrees of relief from symptoms such as abdominal pain and bloating after surgery. On 48 h after admission, the white blood cell count, amylase, lipase, blood glucose levels, and APACHE Ⅱ scores were significantly reduced compared to admission values (all P<0.05). The median time to the first oral intake and length of hospital stay were 72 (48-144) h and 9 (6-16.5) d, respectively. The analysis further revealed that patients with moderately severe disease had significantly better outcomes in terms of ICU admission, time to first oral intake, hospital stay, hospital costs, and CT severity index compared to patients with severe disease (all P<0.05). Most patients had significant peripancreatic fluid collections at admission, and after pancreatic duct stent placement, these collections showed varying degrees of absorption. No severe surgery-related adverse events occurred. Late-stage complications included infected necrosis in 8 cases and walled-off necrosis in 7 cases, of whom 5 cases were cured through pancreatic duct stent drainage, while the remaining 10 cases underwent percutaneous drainage without the need for open surgical debridement or other surgical interventions.Conclusion Early pancreatic duct stent placement in the treatment of ANP can rapidly alleviate symptoms, reduce the incidence of local complications, and decrease the need for subsequent surgical interventions. It is an effective clinical treatment strategy.