GASTROINTESTINAL SYSTEM: Edited by Jan J. De WaeleAdvances in acute pancreatitisSinonquel, Pietera,b; Laleman, Wimc; Wilmer, Alexanderd Author Information aDepartment of Gastroenterology and Hepatology, University Hospitals Leuven bDepartment of Translational Research in Gastrointestinal Diseases (TARGID), Catholic University Leuven cDepartment of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University Hospitals Leuven, Leuven dDepartment of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Belgium Correspondence to Alexander Wilmer, MD, PhD, Department of Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32 16 344275; e-mail: [email protected] Current Opinion in Critical Care 27(2):p 193-200, April 2021. | DOI: 10.1097/MCC.0000000000000806 Buy Metrics Abstract Purpose of review With a potentially life-threatening course, acute pancreatitis (AP) is one of the most common gastrointestinal diseases requiring hospitalization and often necessitating intensive care. Based on recent insights and recommendations, this review provides an overview on clinical management of AP patients with a focus on intensive care unit care. Recent findings Possible benefits of percutaneous paracentesis and/or drainage on outcome or inflammation have been further explored. Combined opioid and epidural analgesia for pain management might be a valuable alternative for pain management. Very recent international guidelines now agree on a step-up approach for the management of acute necrotizing pancreatitis favoring a minimally invasive approach with either endoscopic or percutaneous drainage first. Studies for the best timing of these interventions are ongoing. In spite of a better understanding of pathophysiological mechanisms mediating AP, specific treatments are still awaited. Summary New evidence and recent international consensus direct the current management of AP toward a tailored, multidisciplinary and less invasive therapy with complementary roles for hepatologists, intensivists, radiologists, and surgeons. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.