title: Management of severe acute pancreatitis: it's all about timing.
abstract: OBJECTIVE
  This study provides an update on the treatment of severe acute pancreatitis (SAP) with emphasis on nutrition, infection-prophylaxis, biliary pancreatitis, surgical intervention and new randomized controlled trials.
  
  
  RESULTS
  The most relevant new insights are: (i) early enteral nutrition in SAP is not only capable of reducing infectious complications but may also reduce mortality; (ii) there is increasing evidence that antibiotic-prophylaxis is not capable of preventing infectious complications in SAP; (iii) probiotic-prophylaxis is being considered as an alternative with promising experimental results; (iv) in biliary pancreatitis, early endoscopic retrograde cholangiography with sphincterotomy (within 48 h) is beneficial in case of ampullary obstruction, although it may be withheld in the event of negative endoscopic ultrasound; (v) surgical intervention for infected (peri-)pancreatic necrosis is increasingly being postponed; (vi) minimally invasive strategies are being considered as a full alternative for necrosectomy by laparotomy in infected (peri-)pancreatic necrosis; (vii) the Atlanta classification should no longer be used to describe computed tomography findings in acute pancreatitis; and (viii) only five randomized controlled trials of patients with acute pancreatitis are currently registered in the international trial registries.
  
  
  CONCLUSIONS
  Timing of intervention is becoming increasingly important in SAP management.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. m.besselink@umcutrecht.nl
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Witteman
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000208:Acute Disease; D019072:Antibiotic Prophylaxis; D003422:Critical Care; D004750:Enteral Nutrition; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009752:Nutritional Status; D010195:Pancreatitis / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D019936:Probiotics / Q000627:therapeutic use; D013997:Time Factors