To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

This study proposed to explore the 30-day mortality risk factors in patients with acute pancreatitis (AP) and construct a prognosis nomogram based on the Least absolute shrinkage and selection operator (LASSO) logistic regression. A retrospective study on 965 adult AP patients started from January 2017 and December 2019 was conducted. Feature selection is carried out by using LASSO regression, and the model was established through logistic regression (P < 0.05). The area under the receiver operating characteristic curve (AUC), calibration curves, bootstrap and decision curve analysis (DCA) were utilized for evaluating the performance of the nomogram. A sum of 965 eligible patients were participated, of whom 922 were assigned into a survival group and 43 in a non-survival group. Six independent predictors were identified as the most valuable characteristics in AP patients, including age, activated partial thromboplastin time (APTT), direct bilirubin (DBIL), lactate dehydrogenase (LDH), total protein (TP) and blood urea nitrogen (UREA). The AUC of the nomogram was 0.862 (0.806-0.918). The DCA curve indicates that this nomogram possesses good clinical application value. The nomogram we constructed demonstrates a strong capability in predicting the 30-day mortality of AP patients.

Drugs are a rare but important cause of acute pancreatitis (AP) due to potential therapeutic consequences, accounting for up to 5% of all cases of AP. The diagnosis of drug-induced AP is challenging due to mostly weak evidence and complex diagnostic criteria.

This review article defines drug-induced AP, summarizes the evidence for drugs associated with AP and highlights the challenges in the diagnosis of this condition. The second part of the article focuses on the main pillars of AP treatment.

The association of most drugs associated with AP is based on case reports and case series but there are no high-quality studies. There is sufficient evidence of a causal relationship for only 40 of more than 500 drugs associated with AP and for almost none of the drugs the causal mechanism has been definitively clarified. Several classification systems and criteria have been proposed to assess whether a drug causally triggers AP, with criteria including the temporal association, the exclusion of other causes and recurrence of AP after re-exposure.

The diagnosis of drug-induced AP remains a challenge, with many common drugs being incorrectly associated with AP. There is an urgent need for the development of biomarkers to facilitate the diagnosis of drug-induced AP. Drug treatment for AP is still primarily a needs-based fluid management and efficient analgesia. New and causal therapeutic approaches need clinical validation.

Pancreatic ascites is a rare condition characterized by the accumulation of high-amylase ascitic fluid in the peritoneal cavity. This condition is often associated with chronic pancreatitis, pancreatic trauma, or pseudocyst rupture. Because of its rarity and ill-defined clinical presentation, pancreatic ascites is often a diagnostic and therapeutic challenge in clinical practice. The current diagnostic criteria include an amylase level >1000 mg/dL, a protein level >3 g/dL, and a serum ascites albumin gradient <1.1 g/dL. The clinical features vary, but may include progressive abdominal distension, diffuse abdominal pain, weight loss and peritonitis. The management of pancreatic ascites remains controversial, and there is no consensus regarding the optimal approach. Conservative medical management, which includes nutritional support, pain control, therapeutic paracentesis and the use of somatostatin analogs, has been associated with a high failure rate and significant morbidity. Interventional therapies, such as surgery and endoscopic transpapillary stenting, have shown more promising outcomes. However, the choice between these methods is still debated, with some advocating for endoscopic approaches, because of their minimally invasive nature and reduced morbidity compared with surgical options. Endoscopic approaches remain underutilized in practice, probably because of the need for repeated interventions, the potential risks associated with endoscopic retrograde cholangiopancreatography, or a lack of skilled personnel. Although they show significant perioperative morbidity and mortality, surgical options provide definitive resolution of pancreatic ascites. Herein, we provide an updated review of pancreatic ascites, highlighting advances in diagnostic techniques and therapeutic approaches, and summarizing insights from recent clinical cases and retrospective studies.

There is no effective drug treatment for the organ failure (OF) caused by severe acute pancreatitis (SAP).

We aimed to evaluate the efficacy of cyclooxygenase-2 inhibitors (COX-2-Is) on the treatment of SAP and its safety.

In this multicentre, double-blind, randomised, placebo-controlled, investigator-initiated trial, 348 patients with acute pancreatitis aged 18-75 years, <1 week from onset of illness to admission, and Acute Physiology and Chronic Health Evaluation II Score ≥7 or modified Marshall Score ≥2, were randomly assigned (1:1) to the COX-2-Is group (parecoxib sequential with imrecoxib) or the placebo group. SAP occurrence, duration of OF, local complications, clinical outcomes and serum inflammatory mediators were measured.

Compared with the placebo group, SAP occurrence was reduced by 20.7% (77.6% vs 61.5%, p=0.001) and the persistent OF duration in SAP was shortened by 2 days (p<0.001) after COX-2-Is treatment. For patients enrolled within or after 48 hours from symptom onset, SAP occurrence was reduced by 23.8% (p=0.001) and 8.5% (p=0.202), and the persistent OF duration in SAP was shortened by 3 days (p=0.001) and 2 days (p=0.010) after COX-2-Is treatment, respectively. The occurrence of local complications in the COX-2-Is group was significantly lower than those in the placebo group, 33.7% vs 49.1%, p=0.004. The serum levels of inflammatory mediators and 30-day mortality (from 8.6% to 3.4%) were significantly reduced after COX-2-Is treatment, p<0.05. The incidence of adverse events was similar between the two treatment groups.

Parecoxib sequential with imrecoxib was effective and well tolerated in reducing the occurrence and duration of SAP and local complications through suppression of systemic inflammatory response, leading to decreased morbidity.

Acute pancreatitis is an acute inflammatory disease, which may be associated with pancreatic and peri-pancreatic necrosis and development of (peri)pancreatic fluid collections (PFCs). Interventions in acute pancreatitis have evolved over the years with a paradigm shift from open surgical drainage and necrosectomy to minimally invasive approaches. Depending on the presence of necrosis, the PFCs may be acute necrotic collections or acute pancreatic fluid collections, which evolve over a period of three to four weeks to walled-off necrosis and pseudocysts, respectively. Patients with symptomatic and infected PFCs require drainage. In general, drainage should be delayed beyond three to four weeks when the collection wall has matured and the necrotic debris is liquefied. However, some patients may merit early drainage (within the first three to four weeks), if they have suspected infected pancreatic necrosis and worsening organ dysfunction despite antibiotics and supporting therapy. Endoscopic transmural drainage and necrosectomy have now emerged as the most favored treatment modality in suitable pancreatic collections located predominantly in the lesser sac. Being minimally invasive, per-oral endoscopic direct necrosectomy is as effective as surgical necrosectomy in patients with infected necrotic collections but with fewer adverse events. Percutaneous endoscopic necrosectomy is an important addition to our armamentarium for laterally placed collections as an effective alternative to surgical video-assisted retroperitoneal debridement. The current review provides an overview of the evolution, indications, approaches, techniques and outcomes of endoscopic interventions in the management of pancreatic fluid collections associated with acute pancreatitis. Future direction for better outcomes has been highlighted.

Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pancreatitis (AP), with normal saline (NS) and lactate Ringer's (LR) used most often. Evidence based recommendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials (RCTs). We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions (BS) versus NS on patient-centered clinical outcomes in AP.

From four databases searched up to October 2024, we included only RCTs of adult patients with AP that compared the use of BS (including LR, acetate Ringer's, etc.) with NS. The primary outcome was the disease advances from AP to moderately severe and severe AP (MSAP/SAP). Trial sequential analyses (TSA) were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

Six RCTs were identified and included, involving 260 patients treated with BS and 298 patients with NS. Patients who received the BS had less MSAP/SAP [odds ratio (OR) = 0.50, 95 % confidence interval (CI): 0.29 to 0.85, P = 0.01, I2 = 0 %; 5 studies, 299 patients], reduced need of ICU admission (OR = 0.60, 95 % CI: 0.39 to 0.93, P = 0.02, I2 = 0 %; 5 studies, 507 patients) and shorter length of hospital stay [mean difference (MD) = -0.88, 95 % CI:1.48 to -0.28, P = 0.004, I2 = 0 %; 6 studies, 558 patients; confirmed by TSA with high certainty] compared with those who received NS. The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias, imprecision and inconsistency.

BS, compared with NS, was associated with improved clinical outcomes in patients with AP. However, given the moderate to low quality of evidence for most of the outcomes assessed, further trials are warranted.

Identifying new early predictive markers for the development of severe forms in acute pancreatitis remains a major challenge. The aim of this study was to evaluate the performance of inferior vena cava (IVC) measurement to predict severe acute pancreatitis.

We conducted a single-center retrospective study including patients consecutively hospitalized for acute pancreatitis between 2014 and 2019 who had an abdominal scan within 24 h after admission, before any significant fluid resuscitation. We calculated the ratio of inferior vena cava diameters (IVCR) by dividing the transverse diameter by the anteroposterior. Admission parameters associated with the occurrence of severe acute pancreatitis (persistent organ failure or necrosis infection) were identified by multivariate logistic regression.

Of the 404 included patients, 64 (15.8%) progressed to severe pancreatitis. IVCR in these patients was significantly higher (2.2 ± 0.6 vs. 1.7 ± 0.9, p < .001). In multivariate analysis, IVCR was independently associated with severe pancreatitis (OR = 2.27 95% CI [1.38-3.72], p = .001), as well as visual analog scale, creatinine, albumin, and bicarbonates. The areas under the Receiver Operating Characteristic (ROC) curve of IVCR was 0.67, inferior to systemic inflammatory response syndrome (0.76; p = .03) and Bedside Index for Severe Acute Pancreatitis (BISAP) (0.80; p = .002) in predicting severe acute pancreatitis.

IVCR is associated with the development of severe acute pancreatitis.

Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer's solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to 'rest the pancreas', recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%-75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.

Acute pancreatitis (AP) is an inflammatory disease that can represent a challenge for clinicians, in fact, the early determination of its severity in the first 72 h is crucial for prognosis, recognizing the etiology and carrying out risk stratification to determine a more specific therapy. No accurate early prognostic scores for disease severity have been published, so the severity of AP often cannot be properly defined in the first few hours of the disease. This initial phase represents a "no man's land", in which there is no certainty in the stratification of the damage, prognosis is difficult to establish, therapy must be started promptly, although there is still no effective medical therapy against pancreatic enzymatic activation. Therefore, it is very difficult at this stage to make the correct decisions to achieve the best outcome for the patient with AP. Literature search was carried out using the PubMed database by entering early management of acute pancreatitis [title] or therapy of acute pancreatitis [title] and selecting the most relevant articles for the diagnosis and therapy of acute pancreatitis in clinical practice. This document provides suggestions on managing the key clinical decisions for patients suffering from AP before disease severity is defined, to achieve the best outcomes for patients with AP.

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of left upper quadrant pain to explore the study by de-Madaria et al., titled "Aggressive or moderate fluid resuscitation in acute pancreatitis".

Acute pancreatitis (AP) presents a significant clinical challenge due to its wide range of severity, from mild cases to life-threatening complications such as severe acute pancreatitis (SAP), necrosis, and multi-organ failure. Traditional scoring systems, such as Ranson and BISAP, offer foundational tools for risk stratification but often lack early precision. This review aims to explore the transformative role of artificial intelligence (AI) and machine learning (ML) in AP management, focusing on their applications in diagnosis, severity prediction, complication management, and treatment optimization. A comprehensive analysis of recent studies was conducted, highlighting ML models such as XGBoost, neural networks, and multimodal approaches. These models integrate clinical, laboratory, and imaging data, including radiomics features, and are useful in diagnostic and prognostic accuracy in AP. Special attention was given to models addressing SAP, complications like acute kidney injury and acute respiratory distress syndrome, mortality, and recurrence. AI-based models achieved higher AUC values than traditional models in predicting acute pancreatitis outcomes. XGBoost reached an AUC of 0.93 for early SAP prediction, higher than BISAP (AUC 0.74) and APACHE II (AUC 0.81). PrismSAP, integrating multimodal data, achieved the highest AUC of 0.916. AI models also demonstrated superior accuracy in mortality prediction (AUC 0.975) and ARDS detection (AUC 0.891) AI and ML represent a transformative advance in AP management, facilitating personalized treatment, early risk stratification, and allowing resource utilization to be optimized. By addressing challenges such as model generalizability, ethical considerations, and clinical adoption, AI has the potential to significantly improve patient outcomes and redefine AP care standards globally.

Background/Objectives: Acute pancreatitis (AP) is an inflammatory condition with diverse origins, often resulting in significant morbidity and mortality due to systemic inflammatory response syndrome (SIRS) and multiorgan failure. Fluid resuscitation is pivotal in early management, and it is aimed at preventing hypovolemia-induced ischemia and necrosis. This review evaluates fluid therapy strategies in AP, including fluid types, resuscitation rates, and clinical outcomes. Methods: This systematic review was conducted in January 2025 using databases such as PubMed, Medline, and Google Scholar, focusing on studies published between 2010 and 2024. Search terms included "acute pancreatitis", "fluid resuscitation", and related keywords. Studies involving adults with AP were analyzed to compare the outcomes of crystalloid and colloid use, aggressive vs. moderate fluid resuscitation, and administration timings. The primary outcomes were mortality and severe complications, while secondary outcomes included organ failure, SIRS, and length of hospital stay. Results: Crystalloids, particularly Ringer's lactate (RL), are superior to normal saline in reducing SIRS, organ failure, and intensive care unit stays without significantly affecting mortality rates. Colloids were associated with adverse events such as renal impairment and coagulopathy, limiting their use. Aggressive fluid resuscitation increased the risk of fluid overload, respiratory failure, and acute kidney injury, particularly in severe AP, while moderate hydration protocols achieved comparable clinical outcomes with fewer complications. Conclusions: Moderate fluid resuscitation using RL is recommended for managing AP, balancing efficacy with safety. Further research is needed to establish optimal endpoints and protocols for fluid therapy, ensuring improved patient outcomes while minimizing complications.

The purpose of this study was to investigate the relationship between hematocrit levels and the mortality of patients with acute pancreatitis (AP), since limited research has examined this association in intensive care unit (ICU).

In this study, clinical data were retrieved from Medical Information Mart for Intensive Care database for patients diagnosed with AP. Nonlinear relationships between hematocrit and prognosis were examined through Locally Estimated Scatterplot Smoothing (LOESS) regression, restricted cubic splines (RCS), and U-test analyses. The impact of hematocrit on prognosis was further explored using with a binomial generalized linear model with a logit link, while adjusting for potential confounding factors.

The study encompassed 1,914 patients with AP, revealing a significant difference in hematocrit levels between survivors and non-survivors (33.6 (29.5, 38.1) vs. 32.1 (28.1, 37.4), P < 0.001). Hematocrit emerged as an independent prognostic indicator for mortality in both univariate and multivariate logistic regression analyses (all P < 0.05). Findings from LOESS regression, RCS regression, and the U-test indicated a U-shaped correlation between hematocrit levels and 28-day mortality, with both elevated and decreased hematocrit levels leading to increased mortality risk (P for overall < 0.001). Tertile grouping revealed that lower hematocrit levels (< 30.8%) were associated with heightened 28-day mortality risk (Crude model: Odds ratio (OR) (95%Confidence Interval (CI)) = 1.665 (1.198-2.314); fully adjusted model: adjusted OR = 1.474 (1.005-2.161), all P < 0.05). Survival analyses further supported the adverse prognosis associated with low hematocrit levels.

The findings of this study indicate that in AP patients in the intensive care unit, only low HCT levels were identified as a risk factor for 28-day mortality, despite the presence of a U-shaped correlation between HCT levels and 28-day all-cause mortality.

Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes.

The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model.

The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs.

ClinicalTrials.gov ID: NCT06124989.

Current prediction models are suboptimal for determining mortality risk in patients with acute pancreatitis (AP); this might be improved by using a machine learning (ML) model. In this study, we aimed to construct an explainable ML model to calculate the risk of mortality in patients with AP admitted in intensive care unit (ICU) and compared it with existing scoring systems.

A gradient-boosting ML (XGBoost) model was developed and externally validated based on two public databases: Medical Information Mart for Intensive Care (MIMIC, training cohort) and the eICU Collaborative Research Database (eICU-CRD, validation cohort). We compared the performance of the XGBoost model with validated clinical risk scoring systems (the APACHE IV, SOFA, and Bedside Index for Severity in Acute Pancreatitis [BISAP]) by area under receiver operating characteristic curve (AUC) analysis. SHAP (SHapley Additive exPlanations) method was applied to provide the explanation behind the prediction outcome.

The XGBoost model performed better than the clinical scoring systems in correctly predicting mortality risk of AP patients, achieving an AUC of 0.89 (95% CI: 0.84-0.94). When set the sensitivity at 100% for death prediction, the model had a specificity of 38%, much higher than the APACHE IV, SOFA and BISAP score, which had a specificity of 1%, 16% and 1% respectively.

This model might increase identification of very low-risk patients who can be safely monitored in a general ward for management. By making the model explainable, physicians would be able to better understand the reasoning behind the prediction.

Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration. This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.

Acute pancreatitis is one of the leading causes of mortality and morbidity. Most acute pancreatitis scoring systems have no pathophysiologic basis when evaluating severity. Such a limitation led to an interest in measuring intra-abdominal pressure (IAP) as a method to predict outcomes in patients with acute pancreatitis.

Investigate the predictive impact of intra-abdominal hypertension (IAH) on mortality and clinical outcomes in a patient hospitalized with severe acute pancreatitis.

We conducted a systematic search of the PubMed, Embase, and Cochrane databases from inception through November 2021 for studies evaluating the effect of IAH on acute pancreatitis. Relevant data were extracted and analyzed using STATA 17 software. A random-effects model was used for all variables. Publication bias was assessed using Egger's test.

Fourteen studies investigating 1197 patients were included. Mortality, multiorgan dysfunction syndrome, pancreatic necrosis, renal, respiratory, and cardiovascular failure were more likely in the IAH group. However, infected necrosis and surgical intervention were not statistically significant between the two groups. After excluding abdominal compartment syndrome patients, mortality and respiratory failure were the only outcomes, which remained statistically significant.

Patients admitted to the hospital with severe acute pancreatitis have higher odds for mortality, multiorgan dysfunction syndrome, renal, respiratory, and cardiovascular failure if they developed IAH. IAH remained a strong predictor of mortality and respiratory failure even in the absence of abdominal compartment syndrome. Therefore, the development of IAH is a strong predictor of mortality and poor clinical outcome in such a population.

Necrotizing pancreatitis often demands intervention; contemporary management is directed by the step-up approach. Timing of intervention and specific approach is best directed by a multi-disciplinary team including advanced endosocpists, interventional radiologists, and surgeons with interest and experience managing this complex problem. The intervention is often a combination of percutaneous drainage, transluminal endoscopic approaches, and surgical debridement (minimally invasive or open). Goals of treatment are to evacuate solid infected necrosis, gain enteral access when needed, and to prevent recurrence-cholecystectomy in the setting of biliary pancreatitis. Experienced clinical judgment leads to optimal patient outcomes.

Acute pancreatitis (AP) is an inflammatory condition associated with a potential torpid evolution comprising multiple organ failure, pancreatic necrosis, infected collections and high mortality. Current management tends use the step-up approach, with endoscopic collection drainage, followed by percutaneous drainage by an interventional radiologist and video-assisted necrosectomy. We present our experience with a new percutaneous technique of establishing an anastomosis of the pancreatic collection with the closest loop, stomach, duodenum or jejunum that uses balloon dilation and drainage in cases of infection.

Between 2009 and 2023 we have applied this technique in 30 patients, aged between 32 and 82 years (mean=67 years), 14 with pseudocysts (infected in six cases) and 16 with encapsulated necrosis (all infected). We use dilation balloons of different calibre, to establish the anastomosis between the digestive loop and the collection, as well as different drainages.

The intervention had a primary technical success of 93%. In two patients the cystogastrostomy had to be repeated due to initial technical failure; in both cases a good result was achieved. One patient had a severe postintervention haemorrhage (3%) that required embolisation. Length of follow-up has ranged from between three months and 10 years (mean=4 years), with no recurrence of the anastomosed collection or cutaneous fistula observed in any case.

Percutaneous cystogastrostomy is a technique that allows infected collections to be resolved and pancreatic fistulas to be avoided, with few complications, which can be resolved by interventional vascular radiologists.

Acute pancreatitis (AP) is a highly fatal pancreatic inflammation. In recent years, synthetic nanoparticles have been extensively developed as drug carriers to address the challenges of systemic adverse reactions and lack of specificity in drug delivery. However, systemically administered nanoparticle therapy is rapidly cleared from circulation by the mononuclear phagocyte system (MPS), leading to suboptimal drug concentrations in inflamed tissues and suboptimal pharmacokinetics. To address this challenge, we herein demonstrate a surface masking strategy that involves coating the surface of selenylated Poria cocos polysaccharide nanoparticles with a layer of macrophage plasma membrane to circumvent MPS sequestration, thereby enhancing the therapeutic efficacy of selenylated Poria cocos polysaccharide nanoparticles. Nanoparticles encapsulated with macrophage membranes can simulate the active homing efficacy of macrophages to inflamed lesions during AP, resulting in excessive infiltration of macrophages in pancreatic inflammation sites and prolonged tissue retention time. This technique converts non-adhesive lipid nanoparticles into bioadhesive nanoparticles, increasing local tissue accumulation under inflammatory conditions, including the pancreas and vulnerable lungs. The mechanism is related to targeting pro-inflammatory macrophages. In murine models of mild and severe AP, intravenous treatment with macrophage-mimicking nanoparticles effectively reduces systemic inflammation level and diminishes the recruitment of macrophages and neutrophils. Mechanistic studies elucidate that macrophage membrane-biomimetic selenylated Poria cocos polysaccharide nanoparticles primarily mitigate pancreatic inflammation by inhibiting the AKT/mTOR pathway to reverse autophagic flux impairment. This allows us to envision that the developed biomimetic nanotherapy approach could potentially serve as a novel strategy for pancreatic drug therapy.

Pancreatic cancer (PC) is a leading cause of cancer mortality, often diagnosed at advanced stages. Acute pancreatitis (AP), particularly idiopathic cases, may serve as an early indicator of PC.

This multicenter cohort study investigated the incidence of PC before and after an AP episode, focusing on idiopathic AP and the role of pseudocysts as potential early markers for PC development.

We analyzed data from 2356 AP patients across 25 centers, with a median follow-up of 4.1 years (IQR: 1.6-6.8 years). Patients were categorized into 'PC before AP' and 'PC after AP' groups, and relative risk (RR) and adjusted odds ratios (OR) were calculated for idiopathic AP cases to quantify PC risk.

Among all cases, 69 patients (2.9 %) developed PC: 1.4 % (n = 34) before and 1.5 % (n = 35) after AP. Idiopathic AP cases had a fourfold higher risk of PC (OR = 4.46, [2.25-8.85]). Notably, pseudocysts were five times more prevalent in the PC group (14 %) compared to controls (3 %) (RR = 5.66; p < 0.01), often located at the tumor site. PC developed in 3 % of idiopathic AP cases versus 1.0 % in non-idiopathic cases. The median time to PC diagnosis post-AP was 373 days.

Idiopathic AP and pseudocyst formation significantly elevate the risk of PC, particularly within two years. These findings underscore the need for structured follow-up and early screening in idiopathic AP cases to improve PC detection and survival outcomes.

Increased systemic concentrations of YKL-40 are seen in various inflammatory conditions. We explored the relationship between the serum YKL-40 concentrations and subsequent disease severity in patients with acute pancreatitis (AP).

Consecutive adults with AP were prospectively enrolled, and classified as having mild, moderate or severe disease. On admission and 48 h later, C-reactive protein (CRP), YKL-40, interleukin-6 and 8 (IL-6, IL-8), and tumor necrosis factor alpha (TNF-α) concentrations were measured. Patients were also classified as those with low (<50 ng/mL, in the range seen in 30 age and sex-matched non-AP subjects), high (≥190 ng/mL, seen in most of the other inflammatory conditions), and intermediate YKL-40 (50-189 ng/mL).

Incidence of mild, moderate and severe AP among the 150 enrolled patients was 80 (53.3 %), 59 (39.3 %), and 11 (7.4 %), respectively. Both on admission and 48 h later, high YKL-40 (vs. intermediate or low) was strongly associated with higher odds of a more severe AP, independently of the concurrent IL-8 and TNF-α concentrations (OR around 3.5-4.0, or higher). On admission, the association was independent also of the concurrent CRP, whereas the association between the later concentrations and the outcome was conditional on CRP - uncertain at low, strong at high CRP. The high YKL-40 - outcome association at both time-points was conditional on concurrent IL-6: uncertain if IL-6 was low, strong if IL-6 was high.

Serum YKL-40 is a plausible candidate for further evaluation as an early biochemical indicator of subsequent AP severity, particularly if considered jointly with CRP and/or IL-6.

Acute pancreatitis (AP) is a major health threat, with a high mortality rate in severe forms. Though alcohol and bile-induced factors are the most common causes, increasing evidence suggests that viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) may also trigger AP development. Our study aims to explore this association in greater detail.

After the PROSPERO registration, we systematically searched PubMed, Embase, Cochrane Library, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform in February 2023. We included studies with the following PECO framework: Population: AP patients, Exposure/Comparison: with/without virus infection, Outcome: mortality, severity, and complications of AP. Pooled odds ratios (OR) were calculated with 95 % confidence intervals (CIs).

Altogether, 29 cohorts with 2,295,172 patients were identified for the meta-analysis and 858 cases for the qualitative synthesis. Patients with concurrent SARS-CoV-2 infection and AP exhibited heightened odds of in-hospital mortality (OR: 3.15, CI: 2.08-4.76), and necrosis (OR: 1.83, CI: 1.13-2.97). Mild AP was less prevalent in the SARS-CoV-2 group (OR: 0.37, CI: 0.14-0.97) compared to moderately severe and severe AP together. Contrarily, no evidence was found that concomitant HIV infection elevated in-hospital mortality (OR: 1.12, CI: 0.92-1.37) or sepsis occurrence (OR:1.21, CI: 0.41-3.59).

Patients co-diagnosed with AP and SARS-CoV-2 infection require heightened attention due to an increased risk of mortality and complications. No evidence was found that HIV infection elevated the risk of a more severe outcome.

Acute pancreatitis is a common gastrointestinal disease leading to hospitalisation. Recent advancements in its management have primarily focussed on the development of early phase medical interventions targeting inflammatory pathways, optimisation of supportive treatment (including fluid resuscitation, pain management and nutritional management), appropriate use of antibiotics, implementation of minimally invasive interventions for infected necrosis, and the necessity of follow-up for long-term complications. These advancements have significantly improved personalised management and overall outcomes of acute pancreatitis. Despite these efforts, early-phase medical interventions to mitigate disease progression are still lacking and acute pancreatitis remains a heterogeneous disease. Future research and clinical trials are imperative to further optimise current strategies and develop new therapeutic approaches. This review presents an evidence-based approach to the management of acute pancreatitis, highlighting recent developments.

Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades. The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria: (1) abdominal pain radiating to the back, (2) serum lipase or amylase levels three or more times the upper limit of the normal level, and (3) findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI). The different etiologies include gallstones, autoimmune disorders, alcohol abuse, smoking, hypertriglyceridemia, obesity, drugs, and post-endoscope retrograde cholangiopancreatography (ERCP). The initial investigation includes serum amylase and lipase analysis, a lipid panel including triglycerides, analysis of immunoglobulins, a full blood count, electrolyte analysis, a hemoglobin A1c test, a complete metabolic panel, and transabdominal ultrasound. The initial therapy includes oxygen supplementation, the provision of intravenous fluids, pain control, and a nutrition regime. Early oral feeding is encouraged if tolerated; if not, liquid supplement provision or enteral tube feeding within 48 h of admission has shown better outcomes. Some complications of acute pancreatitis are necrosis, infection, insulin resistance leading to diabetes mellitus, and pancreatic exocrine insufficiency requiring enzyme supplementation. Patients need to attend regular follow-ups and abstain from alcohol and smoking (if warranted) to prevent the recurrence of acute pancreatitis. The mortality rate of acute pancreatitis has decreased in the past few decades because of better management skills, but the recent rise in acute pancreatitis episodes is concerning. Sustained endeavors through clinical trials are required to establish a broad variety of drugs that can be used for acute pancreatitis episodes.

(1) Introduction: One of the most common causes of acute pancreatitis is cholelithiasis, which is considered to be associated with female sex, older age, and recurrence. Our aim was to define a group of patients with B-AP to facilitate their diagnosis and management, while more judiciously using medical resources. (2) Materials and Methods: This retrospective, large cohort study, which was conducted by extracting data from the BUC-API registry, consisted of 1855 cases between 1 June 2015 and 1 April 2022. Each admission of the same patient was considered a separate case if it did not have signs of chronic pancreatitis. Severity and morphology were stratified according to the Revised Atlanta Classification. (3) Results: A total of 732 cases of B-AP were analyzed, with 92.5% occurring at the first attack. The median age was 65 years, with 61.9% of the patients being female. The majority (82.2%) were surgical cases, and the length of stay (LoS) was 7 days. There were 10.2% severe cases, with a mortality rate of 4%. (4) Discussion: We found positive associations between sex, age, recurrence, and morphology and biliary etiology. Compared with the general population, female sex and age over 65 years correlate better with a biliary etiology. In most scenarios, patients suffer from first attacks, with a lower probability of developing local complications. There was a tendency for biliary pancreatitis patients to be admitted to surgical wards.

The use of antibiotic therapy in acute pancreatitis remains controversial and is currently recommended only for confirmed infections of peripancreatic necrosis. However, reliable early predictors of septic complications and unfavorable outcomes are substantially lacking.

Patients with acute pancreatitis were retrospectively reviewed and divided into two groups: one with a septic course defined by pathogen detection [GERM(+)] and one without [GERM(-)]. After propensity score matching, both groups were compared regarding clinical outcomes. Early predictors of pathogen detection were evaluated by multivariate analysis.

424 patients with acute pancreatitis were included. After propensity score matching 123 GERM(-) patients were compared to 74 GERM(+) patients. GERM(+) patients demonstrated significantly worse clinical outcomes with higher rate of intensive care treatment (59.5% vs. 35.0%; p = 0.0011) and consecutive longer stay in intensive care unit (11.5 ± 25.2d vs. 3.0 ± 7.9d; p = 0.0007), longer in-hospital stay (26.8 ± 22.0d vs. 14.7 ± 15.0d; p = 0.0003) as well as worse results in the composite outcome length of in-hospital stay > 15d or death (67.6% vs. 31.7%; p < 0.0001). Prescence of ascites and elevated white blood cell count at the onset of acute pancreatitis were identified as significant predictive factors in the early disease associated with invasive infection and pathogen detection. The most frequently detected pathogens were commensals of the gastrointestinal tract, observed in 70.7% of the examined body fluids and 50.7% of the examined blood cultures.

Detection of pathogens is associated with unfavorable clinical outcomes in acute pancreatitis. The presence of ascites and elevated white blood cell count at onset of acute pancreatitis are significant predictive factors indicating the risk of invasive infection with relevant bacterial load. Thus, an aggressive, early anti-infective strategy against pathogens of intestinal origin should be considered in these cases and may improve patient outcomes.

Acute pancreatitis (AP) is a common paediatric condition, yet there is little data to support optimal analgesic practice. The aim of this scoping review was to report analgesic practice, investigate trends in analgesic strategy and evaluate the impact of analgesic modality on outcomes.

A systematic search of Medline, Embase, CENTRAL, Pubmed Central and Google Scholar was performed by two independent investigators. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

Three retrospective cohort studies, all conducted in North America, reported on analgesic practice in paediatric AP. The studies included 658 patients (median age, 12 years; female sex, 57%; non-biliary aetiology, 85.9%). Overall, analgesia was administered in 67% of patients, including opioids in 59.5% (43.8%-71.4%). Rates of acetaminophen (17.9% and 77.7%) and non-steroidal anti-inflammatory drugs (7.7% and 40.2%) were reported in two studies. Two studies reported reducing rates of opioid administration or reduced duration of opioid administration since 2017 and 2014, respectively. One study did not find any correlation between opioid administration and sociodemographic factors, length of stay or admission to intensive care units. No studies reported on complications or quality of life. No studies investigated non-medical modalities. There were no long-term data on analgesic use post-discharge.

Opioids are the mainstay of pain treatment in paediatric AP in North America. However, factors that influence the analgesic type, the impact of analgesic modality on the post-pancreatitis outcome and long-term analgesic use constitute a knowledge gap. Future studies are needed to inform analgesic use in paediatric AP.

To compare the effect of balanced multielectrolyte solutions (BMESs) versus normal saline (NS) for intravenous fluid on chloride levels and clinical outcomes in patients with predicted severe acute pancreatitis (pSAP).

Isotonic crystalloids are recommended for initial fluid therapy in acute pancreatitis, but whether the use of BMES in preference to NS confers clinical benefits is unknown.

In this multicenter, stepped-wedge, cluster-randomized trial, we enrolled patients with pSAP (acute physiology and chronic health evaluation II score ≥8 and C-reactive protein >150 mg/L) admitted within 72 hours of the advent of symptoms. The study sites were randomly assigned to staggered start dates for a one-way crossover from the NS phase (NS for intravenous fluid) to the BMES phase (sterofudin for intravenous fluid). The primary endpoint was the serum chloride concentration on trial day 3. Secondary endpoints included a composite of clinical and laboratory measures.

Overall, 259 patients were enrolled from 11 sites to receive NS (n = 147) or BMES (n = 112). On trial day 3, the mean chloride level was significantly lower in patients who received BMES [101.8 mmol/L (SD: 4.8) vs 105.8 mmol/L (SD: 5.9), difference -4.3 mmol/L (95% CI: -5.6 to -3.0 mmol/L) ; P < 0.001]. For secondary endpoints, patients who received BMES had less systemic inflammatory response syndrome (19/112, 17.0% vs 43/147, 29.3%, P = 0.024) and increased organ failure-free days [3.9 days (SD: 2.7) vs 3.5 days (SD: 2.7), P < 0.001] by trial day 7. They also spent more time alive and out of the intensive care unit [26.4 days (SD: 5.2) vs 25.0 days (SD: 6.4), P = 0.009] and hospital [19.8 days (SD: 6.1) vs 16.3 days (SD: 7.2), P < 0.001] by trial day 30.

Among patients with pSAP, using BMES in preference to NS resulted in a significantly more physiological serum chloride level, which was associated with multiple clinical benefits (Trial registration number: ChiCTR2100044432).

The primary aim of this study is to determine compliance with key quality performance indicators (QPIs) for the management of acute pancreatitis. The secondary aim is to examine the relationship between compliance to QPIs and clinical outcomes with factors that influence this.

This prospective cohort study will be conducted via the trainee-led STRATA collaborative network. All public hospitals in Aotearoa New Zealand will be eligible to participate. Data will be collected on all adult patients who are diagnosed with acute pancreatitis over a 3 month period. The primary outcome is compliance with the QPIs for the different domains of acute pancreatitis management. Secondary outcomes include early (30-days from index admission) clinical outcomes including incidence of locoregional complications, interventions, organ failure, and mortality.

This protocol describes the methodology for a nationwide prospective cohort study in Aotearoa New Zealand to evaluate compliance based on QPIs derived from the literature. These data will lay the foundation for future registry studies, clinical trials, and quality improvement initiatives.

Open surgical debridement was the main treatment option for infected pancreatic necrosis (IPN). However, it was associated with significant trauma, leading to a higher mortality rate. With the development of minimally invasive surgery, the step-up treatment principle centered around minimally invasive intervention, significantly reducing the incidence of complications and mortality rates among IPN patients. However, few studies have reported the efficacy of laparoscopic retroperitoneal pancreatic necrosectomy (LRPN), a new minimally invasive debridement technique, in IPN patients with duodenal fistula (DF)-a severe complication of IPN. Therefore, we analyzed the effectiveness and safety of LRPN for treating IPN with DF and discussed the impact of DF on patient prognosis.

We retrospectively examined patients diagnosed with IPN between 2018 and 2023. The patients were divided into two groups based on the presence or absence of DF. Clinical characteristics, treatment strategies, clinical outcomes, and follow-up information were analyzed. A 1:1 propensity score-matching (PSM) method was used to assess differences in outcome indicators more accurately.

A total of 197 patients were examined. After PSM, no significant differences were observed between the two groups in in-hospital mortality rate, incidence of single organ failure, rate of postoperative severe complications (Clavien-Dindo Classification ≥ 3), and intensive care unit stay (P > 0.05). However, the incidence of multiorgan failure, gastrointestinal bleeding, number of percutaneous catheter drainage (PCD) procedures, surgery cases, hospital stay, and hospitalization costs were higher in the DF group (P < 0.05). Of these patients, 71.6% (n = 141) were treated with PCD + LRPN, with a conversion rate of 6.38% to open surgery. A higher proportion of patients in the non-DF group showed improved clinical outcomes solely with PCD (22.6% vs. 2.4%, P < 0.05), whereas a higher proportion of patients in the DF group underwent PCD + LRPN (88.1% vs. 67.1%, P < 0.05). Both groups showed a significant reduction in the Sequential Organ Failure Assessment score 72 h postoperatively.

For patients with IPN and DF, the LRPN-centered step-up strategy was safe and effective. DF prolongs hospital stay and increases hospitalization costs for patients.

Severe acute pancreatitis (SAP) is a crucial gastrointestinal disease characterized by systemic inflammatory responses and persistent multiple organ failure. The role of bile acids (BAs) in diverse inflammatory diseases is increasingly recognized as crucial, but the underlying role of BA conjugation remains elusive.

Our study aim to investigate the potential role of conjugated bile acids in SAP and reveal the molecular mechanisms underlying its regulatory effects. We hypothesized that taurochenodeoxycholic acid (TCDCA) and glycochenodeoxycholic acid (GCDCA) could protect SAP through inhibiting the activation of NLRP3 inflammasomes via the TGR5 pathway in macrophages.

To test our hypothesis, we used BA-CoA: amino acid N-acyltransferase knockout (Baat-/-) mice and established SAP mouse models using caerulein- and sodium taurocholate- induced. We utilized a range of methods, including pathology sections, qRT-PCR, immunofluorescence, Western blotting, and ELISA, to identify the mechanisms of regulation.

BA-CoA: Amino acid N-acyltransferase knockout (Baat-/-) mice significantly exacerbated pancreatitis by increasing pancreatic and systemic inflammatory responses and pancreatic damage in SAP mouse models. Moreover, the serum TCDCA levels in Baat-/- mice were lower than those in wild-type (WT) mice with or without SAP, and GCDCA and TCDCA showed stronger anti-inflammatory effects than chenodeoxycholic acid (CDCA) in vitro. TCDCA treatment alleviated SAP in a Takeda G protein-coupled receptor 5 and NOD-like receptor family, pyrin domain containing 3-dependent manner in vivo. Reinforcing our conclusions from the mouse study, clinical SAP patients exhibited decreased serum content of conjugated BAs, especially GCDCA, which was inversely correlated with the severity of systemic inflammatory responses.

Conjugated bile acids significantly inhibit NLRP3 inflammasome activation by activating TGR5 pathway, thereby alleviating pancreatic immunopathology. The results provide new insights into the variability of clinical outcomes and paves the way for developing more effective therapeutic interventions for AP.

Emergency index-admission cholecystectomy (EIC) is recommended for acute cholecystitis in most cases. General surgeons have less exposure in managing "difficult" cholecystectomies. This study aimed to compare the outcomes of EIC between hepatopancreatobiliary (HPB) versus non-HPB surgeons.

This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022. Patients who underwent open cholecystectomy, had previous cholecystitis, previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded. A 1:1 propensity score matching (PSM) was performed to adjust for confounding variables (e.g. age ≥ 75 years, history of abdominal surgery, presence of dense adhesions).

There were 1409 patients (684 HPB cases, 725 non-HPB cases) in the unmatched cohort. Majority (52.3%) of them were males with a mean age of 59.2 ± 14.9 years. Among 472 (33.5%) patients with EIC performed ≥ 72 hours after presentation, 40.1% had dense adhesion. The incidence of any morbidity, open conversion, subtotal cholecystectomy and bile duct injury were 12.4%, 5.0%, 14.6% and 0.1%, respectively. There was one mortality within 30 days from EIC. PSM resulted in 1166 patients (583 per group). Operative time was shorter when EIC was performed by HPB surgeons (115.5 vs. 133.4 min, P < 0.001). The mean length of hospital stay was comparable. EIC performed by HPB surgeons was independently associated with lower open conversion [odds ratio (OR) = 0.24, 95% confidence interval (CI): 0.12-0.49, P < 0.001], lower fundus-first cholecystectomy (OR = 0.58, 95% CI: 0.35-0.95, P = 0.032), but higher subtotal cholecystectomy (OR = 4.19, 95% CI: 2.24-7.84, P < 0.001). Any morbidity, bile duct injury and mortality were comparable between the two groups.

EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion. However, the incidence of subtotal cholecystectomy was higher.

A conservative strategy is the primary modality of treatment for acute pancreatitis of which fluid replacement is an important component. Since the results regarding early aggressive versus moderate fluid replenishment for acute pancreatitis are inconsistent, we sought to compare outcomes between the two resuscitation strategies in our meta-analysis.

We searched MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov for all available randomized controlled trials (RCTs) assessing outcomes for patients treated with aggressive fluid replacement compared to moderate fluid replacement. Our primary outcome was all-cause mortality.

Our meta-analysis included 6 RCTs involving a total of 632 patients. Our results showed that aggressive fluid resuscitation increased the risk of all-cause mortality as compared to moderate fluid replacement (RR 2.40, CI: 1.38-4.19). For all of our secondary outcomes which included the development of organ failure, severe pancreatitis, pancreatic necrosis, clinical improvement, development of SIRS, persistent SIRS, and length of hospital stay, the results indicate that there was no significant difference between the two groups.

Aggressive fluid resuscitation is associated with higher mortality as compared to moderate fluid replacement in patients with acute pancreatitis. RCTs with larger sample sizes are needed to provide greater statistical power and establish more definitive conclusions.

Non-ulcerative necrosis of the stomach and duodenum is rare because of the abundant blood supply in the gastrointestinal tract. Duodenal necrosis is a rare complication of severe acute pancreatitis. Emergency pancreaticoduodenectomy (EPD) is a rare procedure, with extensive duodenal necrosis being one of its indications.

We here report the case of a 57-year-old man who survived EPD for pancreatitis, which resulted in the necrosis of the distal stomach, full-length duodenum, and part of the jejunum.

Despite significant surgical risks, an EPD could be a life-saving procedure in severe cases of pancreatitis.