Current management of acute pancreatitis

The treatment of mild pancreatitis has changed little in recent years, but advances in the management of severe pancreatitis have been associated with significantly reduced morbidity and mortality. Improvements in the recognition of severe disease with scoring systems and serial CT scanning has allowed early goal-directed therapy in appropriate patients. Early aggressive resuscitation and invasive monitoring are standard, with an increased recognition of the role of prophylactic antibiotics and image-guided FNA to diagnose infection. Although the need for aggressive intervention in infected pancreatic necrosis remains unchanged, initial conservative management of most patients with sterile pancreatic necrosis has gained widespread acceptance. Some patients with sterile necrosis may eventually require delayed debridement either for persistent systemic illness or failure to thrive, although accurate prospective identification of these patients has not been possible. For patients who need debridement, open surgical techniques remain the gold standard of management. Advances in minimally invasive technology hold promise as adjuncts to open procedures in the future, particularly as a means of delaying surgery until the necrosis becomes more organized. © 2005 The Society for Surgery of the Alimentary Tract. Published by Elsevier Inc.